Juvenile Idiopathic Arthritis: Symptoms, Diagnosis, Complications, and More

What is Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis was formerly known as juvenile rheumatoid arthritis. It is the commonest type of arthritis in children.

Arthritis is a chronic condition characterized by:

  • Pain in the joints
  • Swelling
  • Stiffness

At least 300,000 American children have some form of arthritis. Some children may experience the condition for just a few months, while others may experience it for several years. In some cases, it may last a lifetime.

The primary cause of juvenile idiopathic arthritis is not known. However, medical experts believe it is an autoimmune condition. In an autoimmune condition, the immune system mistakes harmless cells for invaders and attacks them.

Most cases of juvenile idiopathic arthritis are mild. However, severe cases may trigger complications such as chronic pain and joint damage. So, understanding the symptoms of juvenile idiopathic arthritis is important for getting treatment before the condition degenerates.

Treatment for juvenile idiopathic arthritis includes:

  • Pain management
  • Decreasing inflammation
  • Preventing joint damage
  • Improving function

This will help your child to live an active and very productive lifestyle.

What are the symptoms of juvenile idiopathic arthritis?

Common symptoms of juvenile idiopathic arthritis include:

  • Stiffness
  • Joint pain
  • Reduced range of motion
  • Recurrent fevers
  • Swollen lymph nodes
  • Limping
  • Warm and swollen joints
  • Redness in the affected region

Juvenile idiopathic arthritis may affect several joints in the body. sometimes, the condition can affect the whole body, resulting in a fever, rash, and swollen lymph nodes. This form is called systemic juvenile idiopathic arthritis and accounts for about 10% of juvenile idiopathic arthritis cases in children.

Types of juvenile idiopathic arthritis

It is important to note that there are six types of juvenile idiopathic arthritis.

  • Systemic JIA. It affects the whole body, such as the internal organs, skin, and joints.
  • Oligoarticular JIA. It affects less than five joints in the body. Over 50% of children with arthritis have this form.
  • Polyarticular juvenile idiopathic arthritis. This type of arthritis affects at least five types of joints. Rheumatoid factors may or may not be present.
  • Juvenile psoriatic arthritis. This usually occurs alongside psoriasis and it affects the joints.
  • Undifferentiated arthritis. It involves symptoms spanning at least two subtypes or not fit other subtypes.
  • Enthesitis-related juvenile arthritis. This involves a meeting of the bones with the tendons and ligaments.

The severity of the disease depends on the number of joints that are affected.

Diagnosis for juvenile idiopathic arthritis

JIA may be diagnosed by performing a physical examination. Your child’s healthcare provider may also request a comprehensive medical history.

Various diagnostic tests may be ordered, including:

  • C-reactive protein test. This test helps to determine the amount of C-reactive protein in the blood. C-reactive protein is produced by the liver in response to inflammation. Your doctor may also order an erythrocyte sedimentation rate (ESR).
  • Antinuclear antibody test. This is an antibody to DNA and RNA. Both nucleic acids are located in the cell nucleus. It is created by the immune system in people suffering from an autoimmune condition. An antinuclear antibody test shows the presence or absence of the protein in the blood.
  • Rheumatoid factor test. Rheumatoid factor test detects whether a rheumatoid factor is present in the blood or not. A rheumatoid factor is an antibody produced by your immune system. Its presence is an indication of a rheumatic disease.
  • HLA-B27 test. This test detects a genetic marker associated with enthesitis-related JIA.
  • MRI or X-ray scan. These are imaging tests that rule out conditions that may be causing pain or inflammation from the joint, like fractures and infections. Imaging also reveals some signs of subsets of inflammatory arthritis.

Treatment for juvenile idiopathic arthritis

JIA’s effects can be managed effectively with various treatments. Healthcare providers may recommend several treatments to relieve swelling and pain and enhance strength and movement.

Medical treatment

Naproxen (Aleve), Ibuprofen (Advil), and other nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce swelling and inflammation alongside other treatments. Aspirin is not usually used because of its potential adverse side effects in children.

Stronger medications may be prescribed, for instance, biologics and disease-modifying antirheumatic drugs (DMARDs).

DMARDs help to modify the course of the disease by suppressing the immune system. This prevents an autoimmune attack on the joints.

Medical professionals recommend the use of DMARDs over NSAIDs alone. Initial treatment may be with DMARDs with or without NSAIDs after which biologics may be included.

Examples of DMARDs used for the treatment of JIA include:

  • Leflunomide
  • Sulfasalazine
  • Methotrexate

It is worth mentioning that methotrexate is the most recommended of all DMARDs.

Biologics target specific proteins or molecules that contribute to the disease process. Biologics may be combined with DMARD.

Examples of biologics that decrease joint damage and inflammation include:

  • TNF inhibitors
  • Tocilizumab
  • Rituximab
  • Abatacept

Your child’s doctor may inject a steroid into the affected joint, especially when the symptoms are so severe that they interfere with the ability of the child to perform his/her daily activities. Injection of steroids is not recommended when there are many joints involved. In extreme cases, the joints may be replaced altogether via surgery.

Lifestyle modifications

Exercising and eating healthily have immense benefits for children with JIA. The following lifestyle modifications can help your child to cope easily with their symptoms and minimize the risk for complications:

Healthy eating: Children with JIA usually undergo weight changes. Medications may cause an increase or decrease in their appetite, resulting in rapid weight loss or weight gain. With a healthful diet, your child will have access to the right number of calories that can allow him/her to maintain appropriate body weight.

Consult your healthcare provider or dietitian about a meal plan if your child is beginning to gain or lose a lot of weight as a result of juvenile idiopathic arthritis.

Regular exercise: Exercising at least thrice per week can strengthen your child’s muscles and improve the flexibility of the joint, making it easy to cope with juvenile idiopathic arthritis in the long run. The best exercises are walking, swimming, and other low-impact exercises. It is important though, that you speak to your child’s doctor first.

Physical therapy: A physical therapist will guide your child on the importance of adhering to an exercise routine. He or she may also recommend exercises that suit your child’s condition. Exercises that build strength and enhance flexibility in sore, stiff joints will be suggested by the therapist.

The therapist will work alongside your primary healthcare provider to prevent damage to the joint, as well as bone abnormalities.

Are there any complications to juvenile idiopathic arthritis?

Yes!

If left untreated, juvenile idiopathic arthritis can cause complications, such as:

  • Changes in vision
  • Uneven limbs
  • Pericarditis
  • Stunted growth
  • Anemia
  • Destruction of the joints
  • Chronic pain

Outlook for juvenile idiopathic arthritis

Children with mild cases of JIA can recover without any complications. Note that JIA is a chronic condition that causes flare-ups occasionally. Your child may experience pain and stiffness in the affected joints during these periods. Once the condition advances, a remission becomes very slim. This explains why early diagnosis and treatment are important. Early treatment prevents the development of complications.