Juvenile idiopathic arthritis (JIA) is a childhood disease that causes inflamed, swollen joints. This makes joints stiff and painful. The term "juvenile idiopathic arthritis" is replacing the American "juvenile rheumatoid arthritis" and the European "juvenile chronic arthritis."
Some children with JIA grow out of it after they get treatment. Others will need ongoing treatment as adults.
There are several types of JIA.
Doctors don't really know what causes the disease. But there are a number of things that they think can lead to it. These things include:
Children can have one or many symptoms, such as:
In some cases these symptoms can be mild and hard for you to see. A young child may be more cranky than normal. Or a child may go back to crawling after he or she has started walking. Your child's joints may feel stiff in the morning. Or your child may have trouble walking.
Children with this disease can also get inflammatory eye disease. This can lead to permanent vision problems or blindness if it's not treated. Eye disease often has no symptoms before vision loss occurs.
Your doctor will ask questions about your child's symptoms and past health and will do a physical examination. Your child may also have blood tests and a urine test to look for signs of the disease. If your child has the disease, these tests can help your doctor find out which type it is.
Your child's treatment will be based on the type of JIA he or she has, and how serious it is.
Even when JIA isn't severe, your child may still need long-term treatment. To make sure that treatment is right for your child, work closely with the medical team. Learn as much as you can about your child's disease and treatments. Stay on a schedule with your child's medicines and exercise.
Take good physical care of yourself so that you can help your child through the more difficult periods of illness. Consider finding a support group of families who live with juvenile idiopathic arthritis. Your local chapter of the Arthritis Society can provide classes and support group information.
Learning about juvenile idiopathic arthritis:
The cause of juvenile idiopathic arthritis (JIA) isn't well understood. Most experts believe it is caused by a combination of things, including:
The most common symptoms of all forms of juvenile idiopathic arthritis (JIA) include:
Even though pain is a common symptom of JIA, your child may not be able to describe the pain. Or he or she may be used to the pain. To know if your child is in pain, look for changes such as stiff movements, rubbing a joint or muscle, or avoiding movement.
Other symptoms vary depending on which type of JIA your child has.
can cause fever spikes and rash.
Other conditions with symptoms similar to JIA include growing pains, overuse, injury, bone infection, and certain inflammatory diseases. Many conditions can cause painful, stiff joints in children. Most often, occasional joint pain in children is related to an injury or aggravating factors, such as repetitive overuse in sports activities. JIA is a fairly uncommon cause of these symptoms.
The course of juvenile idiopathic arthritis (JIA) is unpredictable, especially during the first few years after a child is diagnosed. JIA can be mild, causing few problems. It can get worse or disappear without clear reason. Over time, the pattern of symptoms becomes more predictable. Most children have good and bad days.
Of all children who have JIA, 3 or 4 out of 10 children will have long-term disability.footnote 1 Long-term disability may range from occasional stiffness, the need for pain medicine, and limits on physical activity to ongoing JIA and the need for major surgery such as joint replacement. But for most adults who had JIA as children, any long-term problems tend to be mild and don't affect their overall quality of life.
A child's long-term outlook depends on the type of JIA and any complications he or she has. Treatment also affects the child's long-term outlook. Starting treatment early may help lower the chance of long-term disability.
Learn more about the symptoms and what happens in the types of JIA.
Complications linked with JIA can include:
Some children who have polyarthritis get arthritis in the neck that can cause the neck bones to fuse together.
Complications of systemic JIA include heart or lung problems, such as pericarditis, pleuritis, or pericardial effusion. A rare lung complication is the formation of scar tissue in the lungs (pulmonary fibrosis).
No clear risk factors for juvenile idiopathic arthritis (JIA) are known at this time. It may run in families.
Call your doctor immediately if:
Call your doctor if any of the following symptoms continue for more than 2 days:
It can be hard to know when an infant has joint pain. A young child may be unusually cranky or may revert to crawling after he or she has started walking. You may notice gait problems with a walking child or stiffness in the morning.
For a first check of joint pain and other symptoms of juvenile idiopathic arthritis (JIA), consult with your family doctor, general practitioner, or your child's pediatrician.
For more testing and disease management, you may be referred to a rheumatologist who specializes in children's rheumatic disease (pediatric rheumatologist).
The disease management team for JIA may also include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Findings from a physical examination, including the pattern and nature of joint symptoms, are important keys to the diagnosis of juvenile idiopathic arthritis (JIA). Lab tests may be used to support the diagnosis and make sure symptoms aren't caused by another health problem. JIA is often diagnosed only after other possible causes of symptoms have been ruled out and the pain and stiffness have lasted for at least 6 weeks.
Routine examinations and tests include the following:
The following tests are done if needed:
Your doctor will probably schedule routine checkups to see how your child is doing and how well treatment is working. This will include talking about inflammatory eye disease and examinations for this disease, such as a slit lamp eye examination.
Treatment goals for juvenile idiopathic arthritis (JIA) are to reduce your child's joint pain and to prevent disability. Physiotherapy and medicine are the basis of medical treatment for JIA.
Treatment depends on the type and severity of JIA. Even when JIA is uncomplicated, an affected child may need years of medical treatment or checkups. To make sure that your child's care is appropriate for the stage of disease, work closely with the medical team. Learn as much as you can about your child's disease and treatments. And stay on schedule with medicine and exercise.
Your doctor will set up a treatment team. It may include a pediatrician, an ophthalmologist, a rheumatologist, and a physical and/or occupational therapist.
Treatment may include:
To learn more, see Home Treatment and Other Treatment.
Medicine will likely be an important part of your child's treatment.
To learn more, see Medications.
Inflammatory eye disease may develop in children with JIA. This form of eye disease generally has no symptoms and can lead to a permanent decrease in vision or blindness. So part of your child's treatment plan should be regular checkups with an ophthalmologist.
Surgery may be used in a very small number of children with JIA who have severe joint deformity, loss of movement, or pain.
Some children with JIA have no appetite, so malnutrition becomes a medical concern. If your child has little appetite for food, see a nutritionist for help.
The cause of juvenile idiopathic arthritis (JIA) isn't well understood, and there is no way to prevent it. But you can help prevent symptoms. See Home Treatment.
You can do a lot at home to help your child lead a normal life, relieve his or her symptoms, and prevent complications.
Living with JIA often means making lifestyle changes and adjustments. This can be frustrating and demanding for you, your child, and your family. Here are a few steps to help yourself:
Most children with juvenile idiopathic arthritis (JIA) need to take medicine to reduce inflammation and control pain and to help prevent more damage to the joints. When inflammation and pain are controlled, a child is more willing and able to do joint exercises to improve joint strength and prevent loss of movement.
Many different medicines are used to treat JIA. No single medicine works for every child. Your doctor will try to find medicine that helps relieve symptoms and that has few side effects. This may take some time.
Although treatment varies depending on the needs of each child, certain medicines are often tried first (first-line medicines), while others are often saved to try later if they are needed (second-line medicines). Be safe with medicines. Read and follow all instructions on the label.
Some children with JIA gain significant benefit from early methotrexate treatment, and this treatment is becoming more common in an effort to prevent joint and eye damage. Early treatment with methotrexate is often used for polyarticular JIA.footnote 1
Biologic therapy is a newer option to treat JIA that doesn't respond to other treatments. Biologics such as etanercept have had some success in relieving symptoms and decreasing the number of flare-ups.
Combination therapy-such as using methotrexate with sulfasalazine, hydroxychloroquine, or etanercept-has been used on a limited basis to treat JIA. Most medical experience with combination therapy is with adults. Only children with severe JIA that has not improved with methotrexate or sulfasalazine are considered for combination treatment.
Yearly influenza (flu) shots are recommended for children who are on long-term aspirin therapy. Children on long-term aspirin therapy who get chickenpox or the flu are at risk for getting Reye syndrome. Although there is a risk, Reye syndrome is very rare. Very few cases have been reported in children with chronic arthritis who were being treated with aspirin. If your child has been exposed to chickenpox or the flu, talk to the doctor about giving your child acetaminophen to control pain and relieve fever until the incubation period, or the illness itself, has passed.
Surgical treatment may be used in a very small number of children whose juvenile idiopathic arthritis (JIA) has caused severe joint deformity, loss of movement, or pain.
The main things to think about for surgery during childhood are the child's age and whether his or her bones are still growing. If at all possible, joint reconstruction is delayed until childhood bone growth is complete (at about 18 years of age).
When surgery to correct joint deformity is needed, the more common procedures include:
Other surgical procedures for JIA are recommended only in selected cases. These include:
Other treatment for juvenile idiopathic arthritis (JIA) includes physiotherapy and occupational therapy, healthy eating, pain management, and some complementary therapies.
Physiotherapy will be an important part of treatment if your child has severe JIA. The physiotherapist can help set up an exercise program for your child, either for the child to do alone or to do with help from an adult. Exercises should be done every day and should be regularly reviewed by the physiotherapist. The therapist will make sure that the exercises are being done correctly. He or she can decide whether any exercises should be added, dropped, or changed.
Occupational therapy helps a child live as independently as possible.
Any of the following may be used in physical or occupational therapy:
Healthy eating means eating a variety of foods so that your child gets the nutrients he or she needs for growth and development. Good nutrition may also help fight the effects of JIA. Your child can eat all types of food as long as his or her weekly intake is balanced and varied.
Talk to your child's doctor about healthy foods for children with JIA. There are a few nutrients that may be helpful. These include:
Hashkes PJ, Laxer RM (2005). Medical treatment of juvenile ideopathic arthritis. JAMA, 294(13): 1671-1684.
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ByHealthwise StaffPrimary Medical ReviewerSusan C. Kim, MD - PediatricsBrian D. O'Brien, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerJohn Pope, MD - Pediatrics
Current as ofOctober 31, 2016
Current as of: October 31, 2016
Susan C. Kim, MD - Pediatrics
& Brian D. O'Brien, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & John Pope, MD - Pediatrics
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