The Symptoms and Treatment of Juvenile Idiopathic Arthritis

Kids get arthritis. In fact, according to the Arthritis Foundation, about 300,000 kids in the United States have chronic arthritis or juvenile idiopathic arthritis (JIA).

Fortunately, it is much more common that kids have aches and pains that are not caused by arthritis, especially when they have growing pains. Still, arthritis is often the first thing many parents think of when the kids have joint pain. That makes it important to understand the signs and symptoms of juvenile idiopathic arthritis so that you can avoid unnecessary tests and get your child diagnosed if he does indeed have JIA.

One of the most important things to understand is that when doctors talk about arthritis, they are not just referring to pain. The true definition of arthritis includes joint inflammation and usually includes swelling and/or pain with motion and a limited range of motion. If your child just has pain without inflammation, then it is called arthralgia.

The swelling that children have with arthritis, especially if it is in a small joint, can sometimes be subtle, though, which can make the diagnosis of juvenile idiopathic arthritis difficult. And although many parents think that you can diagnose a child with juvenile idiopathic arthritis with a few quick blood tests, while helpful, these tests can't make the diagnosis by themselves. They can even confuse things sometimes.

So while you should see your pediatrician if your child has aches and pains that you are concerned about, don't be surprised if he tells you that your child doesn't have JIA unless he has some of the signs and symptoms discussed below.

Types

Juvenile arthritis is actually not just one condition.

Many things can cause arthritis in children, including infections (septic arthritis), reactions to infections (reactive arthritis), and other conditions (SLE, HSP, etc.)

There are many different types of juvenile idiopathic arthritis too, including:

• Systemic Arthritis
• Oligoarthritis: Only 1 to 4 joints are affected during the first six months
• Polyarthritis: Can be either rheumatoid factor negative or positive - 5 or more joints are affected during the first six months
• Psoriatic Arthritis
• Enthesitis-Related Arthritis: Have inflammation where a tendon inserts onto a bone
• Undifferentiated Arthritis

What happened to JRA or juvenile rheumatoid arthritis? That is an older term that was replaced when the latest classification rules were developed in 2001.

Symptoms

Juvenile idiopathic arthritis symptoms and signs can include:

• Joint swelling
• Joint pain
• Joint stiffness that is usually worse in the morning
• A high fever (systemic JIA)
• Salmon-colored skin rash (systemic JIA)
• Swollen lymph glands (systemic JIA)
• Swollen fingers and nail pitting (psoriatic JIA)
• Lower back pain (enthesitis-related arthritis)
• Eye inflammation (oligoarthritis)

Most importantly, to be diagnosed with JIA, a child should be younger than 16-years-old at the onset of arthritis and should have at least 6-weeks of joint swelling.

Diagnosis

So how are children with juvenile idiopathic arthritis diagnosed?

Unfortunately, you can't just order a blood test and know whether or not a child has JIA. Many of the tests are non-specific. For example, the erythrocyte sedimentation rate (ESR) test simply says that inflammation is present in the body, but doesn't tell you if it is from JIA or an infection. And many kids with JIA have a normal antinuclear antibody (ANA) test, which is often thought of as an "arthritis test."

Instead of a panel of tests, it is your child's pattern of signs and symptoms and a few targeted tests that will likely help your pediatrician and/or a pediatric rheumatologist diagnose your child with JIA.

Treatments

Although there is no cure for juvenile idiopathic arthritis, there are many treatments that can help control symptoms and prevent symptoms are flaring up, including nonsteroidal anti-inflammatory drugs (E.G., aspirin, ibuprofen, and naproxen), disease-modifying antirheumatic drugs (E.G., methotrexate), prednisone, and biologic agents (E.G., etanercept, infliximab, and adalimumab).

Physical therapy and occupational therapy are other treatments that children with JIA often need.

What You Need to Know

Other things to know about juvenile idiopathic arthritis include that:

• JIA is thought to have both genetic and environmental causes.
• Oligoarticular JIA is the most common type of JIA and has a peak onset between the ages of 2 and 4 years.
• Iridocyclitis (inflammation in the eye) is a serious complication of JIA. Children with JIA typically see a pediatric ophthalmologist make sure they aren't developing eye inflammation.
• Children with JIA should be monitored for growth problems.

A pediatric rheumatologist can help to diagnose and manage your child with JIA.