Juvenile idiopathic arthritis (JIA)

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children younger than age 16. JIA is called idiopathic because the cause is not known. It happens when the immune system becomes overactive and causes inflammation in the body.

JIA can cause persistent joint pain, swelling and stiffness. For some children, these symptoms may last only a few years. For others, they can continue for many years.

Certain types of JIA can lead to serious complications, including slowed growth, joint damage and inflammation in the eyes. Treatment aims to lessen pain and swelling, help joints work better and prevent long-term damage.

The most common signs and symptoms of juvenile idiopathic arthritis are:

• Pain. Your child may not complain of joint pain, but you may notice a limp, especially first thing in the morning or after a nap.
• Swelling. This often happens in larger joints, such as the knees.
• Stiffness. Your child may seem more awkward or clumsy than usual, especially after sleeping or resting.
• Fever, swollen lymph nodes and rash. In some cases, your child may have a high fever, swollen lymph nodes, or a rash on the chest, back or stomach. These symptoms often get worse in the evening.

JIA can affect one joint or many. The main types are oligoarticular, polyarticular and systemic. Oligoarticular JIA affects a few joints. Polyarticular JIA affects five or more joints. And systemic JIA affects the joints and also causes symptoms throughout the whole body, such as fever or a rash on the back, belly or chest. The type classification depends on your child's symptoms, how many joints are affected, and whether fever or rash are present.

Like other forms of arthritis, JIA often comes in cycles. There are times when symptoms get worse, called flare-ups. And there are times when symptoms improve.

When to see a doctor

It's important to see a healthcare professional early if your child has swollen or stiff joints. Waiting too long to start treatment can lead to joint damage, make the treatment less effective and cause other health issues.

With treatment, most children have periods when they have no symptoms and the disease is not active. In some children JIA goes away completely. No further treatment is needed. But for some, it may be a lifelong condition that requires treatment into adulthood.

Juvenile idiopathic arthritis happens when the body's immune system mistakenly attacks its own healthy cells and tissues. It's not known why this happens, but both inherited traits and environmental factors may play a role.

Some forms of juvenile idiopathic arthritis are more common in girls than in boys. The reason for this is not fully understood. But researchers believe it may be linked to differences in hormones and the immune system. Genetics also may play a role, as certain inherited traits can make a child more likely to develop JIA.

Juvenile idiopathic arthritis can lead to serious health conditions. Watching your child's symptoms closely and getting regular medical care helps lower the risk of these complications.

• Eye issues. Some types of JIA can cause eye inflammation, also called uveitis. If not treated, this can lead to cataracts, glaucoma or even blindness. Because eye inflammation often has no warning signs, children with JIA need regular checkups with an eye doctor, called an ophthalmologist.
• Growth problems. JIA can slow a child's growth and affect how bones develop. Some treatments, especially corticosteroids, also can slow growth.

Diagnosing juvenile idiopathic arthritis can be challenging because many conditions can cause joint pain. There's no single test to confirm JIA, but certain tests can help rule out other conditions with similar symptoms.

Your child's healthcare professional typically asks about symptoms and when they began. You may be asked about your child's family medical history because autoimmune conditions like JIA can run in families. Your child's healthcare professional may look for signs of trouble walking, moving the neck, or raising or closing the hands. They may check your child's eyes to look for issues that come from inflammation.

Blood tests and imaging scans also can help diagnose JIA.

Blood tests

Common blood tests your child's healthcare professional may order include:

• Erythrocyte sedimentation rate (ESR). This test measures how quickly red blood cells settle at the bottom of a test tube. A higher number on the test can mean there is inflammation in the body.
• C-reactive protein (CRP). This test measures inflammation but uses a different method than the ESR.
• Antinuclear antibody (ANA). This test detects proteins often found in people with autoimmune diseases, including some types of arthritis. If your child tests positive for ANA, there is a higher risk of developing eye inflammation. Regular eye exams are important to check for this condition.
• Rheumatoid factor (RF). This test looks for an antibody that may be present in some children with JIA and can signal a higher risk of joint damage.
• Cyclic citrullinated peptide (CCP). This test looks for another antibody that, like RF, can be linked to a higher risk of joint damage.

Many children with JIA have results in the standard range on these blood tests.

Imaging scans

X-rays or MRI scans may be done to rule out other issues such as broken bones, tumors, infections or birth defects.

After diagnosis, imaging may be repeated from time to time to check how bones are growing and to look for signs of joint damage.

The main goal of treating juvenile idiopathic arthritis is to help your child stay active, take part in everyday life and avoid long-term health issues. Healthcare professionals often combine different treatments to:

• Relieve pain and swelling.
• Keep joints moving well and maintain strength and flexibility.
• Prevent issues such as joint damage or growth delays.
• Support your child's physical, emotional and social development.

Most children with JIA need a mix of medicines and healthy habits, such as a balanced diet and exercise, to reach these goals. The treatment plan depends on your child's age, the type of JIA they have, and how serious symptoms are.

Medications

Medicines are chosen to lessen pain, improve movement and lower the risk of lasting joint damage. Common options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medicines such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can lessen pain and swelling. Possible side effects include stomach upset and, less often, kidney or liver issues.
• Disease-modifying antirheumatic drugs (DMARDs). These medicines are used when NSAIDs alone are not enough to ease symptoms of joint pain and swelling or if there is a higher risk of joint damage. DMARDs slow the progress of juvenile idiopathic arthritis and may be taken with NSAIDs. The most common DMARD for children is methotrexate (Trexall, Xatmep, others). Possible side effects include nausea, low blood counts, liver issues and a slightly higher risk of infection.

• Biologic agents. These newer drugs target the immune system in specific ways to lessen inflammation and protect joints. Also known as biologic response modifiers, they include tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi) and infliximab (Remicade, Inflectra, others).

  Other biologic agents include abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret) and tocilizumab (Actemra). They may be used with DMARDs and other medicines. All biologics raise the risk of infection.

• Corticosteroids. Medicines such as prednisone can quickly control symptoms especially if inflammation affects areas outside the joints, such as the sac around the heart. Because they can slow growth and increase infection risk, these medicines usually are given for the shortest possible time.

Therapies

• Physical therapy. A physical therapist can teach your child exercises to keep joints flexible, maintain movement and strengthen muscles.
• Occupational therapy. An occupational therapist can show your child ways to protect their joints, suggest helpful equipment and give tips for making daily tasks easier.
• Counseling. Mental health professionals help children cope with difficulties at home and at school that may come from living with JIA.
• Joint supports or splints. These devices can help protect joints and keep them in a healthy position for movement.

Surgery

In very serious cases, surgery may be needed to improve joint function or to treat cataracts.

Parents and caregivers can help children with JIA learn self-care habits that lessen symptoms and protect joint health. These include:

• Regular exercise. Staying active helps keep muscles strong and joints flexible. Swimming is a great choice because it's gentle on the joints.
• Eating a healthy diet. Some children with JIA may lose their appetites, while others may gain weight because of medicines or less activity. A balanced diet helps keep weight in a healthy range.
• Using cold or heat. Many children with JIA feel stiff in the morning. Warmth — such as a heating pad or warm bath or shower — often helps. Cold packs can lessen swelling and discomfort, especially after physical activity. Always place a thin towel between a cold pack and your child's skin.
• Getting enough calcium. Juvenile idiopathic arthritis, corticosteroid use and less physical activity can increase the risk of weak bones. A calcium-rich diet helps keep bones strong.

Family support plays an important role in helping children manage juvenile idiopathic arthritis. Parents can take these actions:

• Treat your child as much like their siblings and peers as possible.
• Let your child share feelings, including frustration or anger about having JIA. Reassure your child that it's not their fault.
• Encourage safe physical activities, following the advice of your child's healthcare team.
• Communicate with teachers and school staff so they understand your child's needs and any necessary accommodations.

If your child's pediatrician or family healthcare professional suspects that your child has juvenile idiopathic arthritis, you may be referred to a doctor who specializes in arthritis, called a rheumatologist, for diagnosis and treatment planning.

What you can do

Before the appointment, it can help to make a list that includes:

• A detailed description of your child's symptoms.
• Any past medical concerns your child has had.
• Medical conditions that run in your family.
• All the medicines and dietary supplements your child takes.
• Your child's vaccination history.
• Questions you want to ask.

What to expect from your doctor

Your child's healthcare professional may ask questions such as:

• Which joints seem to be affected?
• When did the symptoms start? Do they come and go?
• What makes the symptoms better or worse?
• Is stiffness worse after resting or sleeping?