What is Juvenile Idiopathic Arthritis?

Diagnosing JIA 

Types of JIA

Healthcare Team for JIA

How is JIA treated?

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What is Juvenile Idiopathic Arthritis (JIA)?

Juvenile Idiopathic Arthritis, also known as JIA, is the name given to several forms of arthritis in children and teenagers.

Juvenile means the arthritis begins before the age of 16, idiopathic means the cause is not known and arthritis means one or more joints are inflamed – that is, swollen, painful, stiff and they may not have as much range of movement as other joints.

JIA is an auto-immune condition, where the immune system gets confused and attacks healthy joint tissue, causing inflammation.

JIA can sometimes be seen in conjunction with other autoimmune conditions and while it principally affects the joints, it may also affect other organs including the eyes.

Every year approximately 1 in 10,000 children in Ireland is diagnosed with JIA making it almost as common as childhood diabetes. It can begin at any age, although it is most common in younger children and while it can develop in both boys and girls, most types are more common in girls.

For the vast majority of these children, arthritis is not the same as in adults.

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Diagnosing JIA 

A formal diagnosis should always come from a specialist paediatric rheumatologist working within a multidisciplinary team. The diagnostic process, which is the first key step in determining a treatment plan, may include the following –

  • A full history of symptoms
  • Clinical examination
  • Blood tests
  • Ultrasound scan and/or x-ray

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Types of JIA

There are several types of arthritis grouped under the umbrella term JIA, however the symptoms can vary. Just because something happens to one child, doesn’t mean it will happen to every child. 

Oligoarticular Arthritis

  • Four or fewer joints affected in first six months
  • If arthritis develops in other joints after the first 6 months, it will then be called extended oligoarticular arthritis

Polyarticular arthritis

  • Five or more joints affected in first six months
  • Can be further categorised as rheumatoid factor negative or even less commonly rheumatoid factor positive

Enthesitis related arthritis

  • When arthritis is associated with inflammation in the area where tendons attach to the bone (Enthesitis)
  • The most typically affected areas are the heel, arch of the foot, hips and knees

Psoriatic Arthritis (PsA)

  • Can affect any joint but often involves the fingers and toes
  • There may have been a swollen, ‘sausage’ shaped toe in a young child, which got better on its own; known as dactylitis [dak-ti-li-tis]
  • Psoriasis is a scaly rash typically affecting the knees and elbows, PsA can often be diagnosed where there is no evidence of psoriasis in a child, but a family member has psoriasis

Systemic Onset JIA

  • This is diagnosed if your child has arthritis and a typical pattern of recurrent fever and rash

Undifferentiated Arthritis

  • This means that a child/teenager’s symptoms don’t fit neatly into any one of the other types of JIA 

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Healthcare team

A child/teenager’s healthcare team may include some or a number of the following people. This will be as appropriate for each child according to their treatment plan.

Consultant paediatric rheumatologist or adult rheumatologist who sees children

They will be responsible for making the diagnosis and giving details of the management plan

Paediatric specialist nurse (or adult specialist nurse)

A specialist nurse has a degree of specialist expertise, knowledge and skill in a particular area and works closely with the consultant. They are often the key regular contact with families affected by JIA, providing education and support

Physiotherapist

A physiotherapist provides expert therapy to help maximise a child or young person’s movement and help them control pain in their joints and muscles. The physiotherapist’s role is to facilitate activity and participation, and provide guidance on sports and activities.

Occupational therapist (OT)

An occupational therapist can help a child take a more active role in life through helping them in the areas of playing and learning. They will encourage participation in everyday tasks and facilitate changes needed to allow this to happen

Ophthalmologist

An eye doctor who will have an expert knowledge of uveitis which is a condition that can be linked to JIA

Podiatrist

An expert in foot health, they will treat a wide range of problems affecting the feet, ankles and lower legs

Psychologist

A psychologist helps people with a number of problems, including behaviour, thoughts and feelings.

Radiographer

A radiographer is trained to operate and use equipment that takes images of the inside of different parts of the body. This includes x-rays, CT scans, MRI scans, ultra-sound. 

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How is JIA treated?

It’s important to say that whilst it can be a scary prospect to consider that your child may have to take medication for many years, not taking the drugs recommended by the health professionals can have long-term consequences. Unfortunately, the evidence shows that not taking the recommended medication can lead to damaged joints which never recover. Untreated or under-treated JIA in children could result in further health problems.

Your child will be continuously monitored, and side-effects can usually be effectively dealt with in several ways.

Once your diagnosis is confirmed, there are many treatments that can ease your pain and increase your movement. Non-medication therapies such as physiotherapy, physical activity and relaxation techniques can all be helpful in the treatment of JIA. There is, though, a range of prescription drugs that are used to help people manage the disease. These drugs can’t cure your arthritis but will help you to manage the symptoms and limit the risk of joint damage.

Painkillers

Painkillers are pain-relieving drugs that do not affect the arthritis itself but help relieve the pain and stiffness. Paracetamol is one of the most common painkillers given for JIA and can be taken in liquid form for infants and orally (tablets) for older children. They come in varying strengths and the stronger ones are only available on prescription. It is important to take the correct dose according to the children’s weight and age.

Paracetamol is regarded as a safe medicine with relatively few side effects, however, in excess can damage the liver. Some patients report stomach upset. Never take more than the recommended dose and, if in doubt, talk to your pharmacist or doctor.

Paracetamol-based combination analgesics are also available on prescription. These usually contain opioids in low doses such as tramadol or codeine. Opioids are more likely to cause side effects including constipation or dizziness.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs help to ease pain, stiffness and swelling by reducing inflammationExamples include ibuprofen (suitable for all ages), meloxicam and naproxen. These drugs can be taken in liquid form or oral form (tablets). 

In order to avoid common side-effects, such as indigestion and stomach problems, it is recommended to NOT take NSAIDs on an empty stomach. You should contact your doctor or rheumatology nurse specialist if you experience any cramps or stomach problems.

Disease modifying anti-rheumatic drugs (DMARDs)

DMARDs ease the pain, swelling and stiffness but also dampen down inflammation and prevent joint damage caused by arthritis. Methotrexate, sulfasalazine (usually only given to older children) and hydroxychloroquine (usually only given to older children) are examples of standard DMARDs. These are usually the first DMARDs prescribed on diagnosis. 

DMARDs reduce the immune system ‘attack’. They take time to work (weeks, even months). These drugs provide a way of controlling the disease over the long term, dependent on the type of JIA. Sulfasalazine and hydroxychloroquine are in tablet form only. Methotrexate comes in tablets, liquid form or sub-cutaneous injectionSide-effects are rare, but you'll need to have frequent blood tests to monitor for them.

Leflunomide is an infrequent DMARD that is only used occasionally and in tablet form.

Biologic therapies

Biologic therapies work by targeting particular chemicals or cells in the body’s immune system. biologic drugs work similarly as DMARDs; they not only reduce pain, stiffness and swelling, but also slow down the progression of arthritis. Biologic drugs give better control for children and young people who do not respond well to DMARDs.

The most common ones used for JIA are etanercept, adalimumab, infliximab, tocilizumab, abatacept, anakinra and canakinumab (rarely used). They may be prescribed together with a standard DMARD. Etanercept and adalimumab are given by sub-cutaneous injection and tocilizumab and abatacept are given by intravenous infusion.

Eye care

Children and young people with JIA can develop inflammation in their eyes as well as their joints, which is called uveitis. 10 to 30% of children and young people with JIA develop uveitis. 

In the early stages there are often no symptoms, however if they do occur they generally include eye pain, redness of the eye and blurred vision. If left untreated, uveitis can lead to gradual loss of vision and occasionally blindness. Therefore, it is vital that all children and young people with JIA are referred for assessment by an ophthalmologist.

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For more in depth information on Juvenile Idiopathic Arthritis, and information on eye care, managing flares, physical activity, nutrition, and transitioning to adult care, contact our Services Support Officer 01-6470202 or our Helpline on 0818252846 [email protected] 

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