JUVENILE IDIOPATHIC ARTHRITIS: CAUSES, SYMPTOMS, TREATMENT AND MORE

Medically Reviewed by Dr. Sony Sherpa (MBBS)

Juvenile Idiopathic Arthritis (JIA) is an autoimmune arthritic ailment that affects children under 16 years. Although rare, it is the most common type of arthritis in children and can significantly affect their day-to-day activities.^[1]

In this article, we will explore what JIA is, its causes, types, symptoms, diagnosis, treatment, and the latest advancements in managing this condition.

What is Juvenile Idiopathic Arthritis (JIA)?

Juvenile Idiopathic Arthritis (JIA) is a type of arthritis that concerns children and adolescents. It is an autoimmune disease, which means that symptoms manifest when the body's immune system incorrectly attacks healthy cells and tissues. This results in inflammation, pain, and stiffness in the joints.

JIA is a chronic condition that can last for a long time or even a lifetime. It is also known as Juvenile Rheumatoid Arthritis (JRA) or Juvenile Chronic Arthritis (JCA).

Causes of JIA

The exact cause of JIA is still unknown. However, research suggests that it is a combination of genetic, environmental, and immunological factors. Children with a family history of autoimmune diseases are more likely to develop JIA.

The HLA-DR genes code for human leukocyte antigen class II molecules, specifically the HLA-DR alpha and beta chains. These molecules present T-cell antigens, which are crucial to the immune response.

In the context of JIA, specific HLA-DR alleles have an association with developing particular JIA subtypes. For example, the presence of a higher number of HLA-DR risk alleles may lead to an earlier onset of JIA. Furthermore, different HLA-DR alleles are associated with other types of JIA, such as oligoarticular, polyarticular, and systemic JIA.^[2]

Exposure to infections, toxins, stress, and other environmental factors may also trigger the onset of JIA in children who are genetically predisposed to the condition. Common pathogenic culprits may include Epstein-Barr virus, Parvovirus B19, enteric bacteria, streptococcal infections, and Chlamydophila pneumoniae.

Other experts suspect that hormonal changes during puberty may also contribute.

Types of JIA

There are many types of JIA, each with its unique characteristics and symptoms. Most types are more prevalent in girls than boys.

The most common types of JIA are^[3]:

• Oligoarticular JIA is the most common type, accounting for 50-60% of all cases. It usually affects the knees, ankles, wrists, and four or fewer joints in the first six months of the disease.
• Polyarticular JIA occurs in five or more joints in the first six months of the disease. It can affect any joint in the body, including the small joints in the hands and feet. This type of JIA is more common in girls than boys.
• Systemic JIA is the least common type of JIA, accounting for about 10-15% of all cases. It affects the whole body, causing symptoms such as fever, rash, and inflammation of internal organs. Additionally, it may result in joint pain and swelling. This type, also known as Still's disease, affects both sexes equally.
• Enthesitis-related JIA affects the entheses, which refer to the connections of tendons and ligaments to the bones. It usually affects the lower limbs, especially the knees and ankles. It is more common in boys than girls.
• Psoriatic JIA is a type of JIA synonymous with psoriasis, a skin disorder that results in red, scaly patches. It can give rise to joint pain, stiffness, swelling, and skin and nail changes.
• Undifferentiated arthritis refers to arthritis that presents symptoms of two or more of the JIAs mentioned above. Alternatively, the symptoms may not correspond to any known type of JIA.

Symptoms of JIA

The symptoms of JIA can vary depending on the type of JIA and the severity of the disease. Some common symptoms of JIA include^[4]:

• Joint pain, warmth, morning stiffness, and swelling
• Restricted range of motion in the involved joints
• Fatigue and weakness
• Difficulty with performing daily activities such as walking, dressing, and playing
• Fever
• Rash
• Eye inflammation
• Swollen lymph nodes (Still's disease)

Growing pains vs JIA: Growing pains are usual in children, but unlike JIA, they^[5]:

• Typically occur in the legs, not joints.
• Do not cause swelling, warmth, or morning stiffness.
• Tend to happen in the evening.

Complications

If left untreated or poorly managed, JIA can cause:

• Growth Issues: Inflammation can affect bone development, leading to stunted growth and deformity.
• Chronic (long-term) arthritis: This can lead to ongoing pain and limitations.
• Disability (loss of function): In severe cases, JIA can affect daily life significantly.
• Vision problems: Untreated eye inflammation can lead to vision loss and even blindness.

Diagnosis of JIA

There is no single test available for reaching a definitive diagnosis of Juvenile Idiopathic Arthritis. Instead, doctors rely on a combination of tools and information to reach a diagnosis. The diagnosis of JIA often involves ruling out other conditions with similar symptoms, such as infections, Lyme disease, or other forms of arthritis.

Here are some standard diagnostic protocols:

• Detailed Medical History: Your child's doctor will ask about symptoms, duration, and any family history of autoimmune diseases or arthritis.
• Physical Examination: The doctor will examine joints for swelling, warmth, pain on movement, and range of motion limitations. They may check other areas like the eyes and skin.
• Blood Tests: Several blood tests help assess inflammation, detect antibodies, and rule out other conditions:
  • Antinuclear Antibody (ANA) and other antibody tests: Checks for antibodies associated with autoimmune diseases.
  • Complete Blood Count (CBC): Assesses red blood cells, white blood cells, and platelets.
  • Complement Test: Measures levels of specific proteins involved in the immune system.
  • Erythrocyte Sedimentation Rate (ESR or sed rate) & C-reactive Protein (CRP): Detect overall inflammation levels.
  • Creatinine: Evaluates kidney function, which may be necessary when considering medication options.
  • Hematocrit: This is a measure of the percentage of red blood cells in the blood.
  • Rheumatoid factor (RF): Checks for an antibody associated with rheumatoid arthritis.
  • CCP: Measures an antibody particular for rheumatoid arthritis.
• Imaging Tests: X-rays, MRIs, and bone scans can be used to visualize joint changes and rule out other causes
• Eye Exam: Since some JIA types can cause eye inflammation, routine eye exams at an ophthalmologist’s office are essential, even in the absence of symptoms.^[6]
• Joint Aspiration (Arthrocentesis): This involves withdrawing a small amount of fluid from a swollen joint for analysis. It can help rule out infection or other causes of inflammation.

Treatment for JIA

The treatment for JIA aims to control inflammation, relieve pain, and improve the child's quality of life. A treatment plan requires a high degree of personalization and may include a combination of medication, physical therapy, and lifestyle changes.

Medication

Medication is an essential part of the treatment for JIA. The prescribed medication will depend on the type and severity of the disease. Some common medications used to treat JIA include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
• Disease-modifying antirheumatic drugs (DMARDs) to slow down the progression of the disease
• Biologic agents that home in on specific parts of the immune system
• Corticosteroids to reduce inflammation and pain

Physical Therapy

Physical therapy can aid with improving joint function, reducing pain, and preventing deformities. A physical therapist can design an optimal exercise program, tailored to the child's needs and abilities.

Occupational Therapy

Occupational therapy can be a practical intervention for children with juvenile idiopathic arthritis to help them overcome limitations and participate in daily activities. An occupational therapist can guide them in how to perform and cope with daily tasks and use assistive devices.^[7]

This therapy aims to enhance their independence and functionality while managing their symptoms.

Lifestyle Changes

Making specific lifestyle modifications can also help to keep JIA symptoms under control. These may include^[8]:

• Eating a healthy, balanced diet to preserve a healthy weight and nourish the body with essential nutrients
• Focusing on bone healthy supplementation such as vitamin D, calcium, and omega-3 fish oil
• Getting enough rest and sleep to reduce fatigue and promote healing
• Using braces, splints, or other assistive devices to support the joints and reduce pain
• Avoiding activities that place the joints under stress, such as high-impact sports

Latest Advancements in Managing JIA

Advancements in medical technology and research have ushered significant improvements in the management of JIA. Some of the latest advancements include:

• Biologic Agents: Biologic agents are medications that target specific parts of the immune system. They are effective in treating JIA, especially in children who do not respond to other treatments. For example, JAK inhibitors offer a new treatment option by blocking inflammation-causing enzymes, especially for children with systemic JIA^[9].
• Stem Cell Therapy: Stem cell therapy appears as a favorable treatment option for JIA. It concerns using stem cells to restore damaged tissues and reduce joint inflammation^[10]. While still in the early stages of research, stem cell therapy shows promise in alleviating symptoms^[11] and lowering the need for medication in children with JIA.
• Personalized Medicine: Genetic analysis could help doctors predict which medications will work best for individual children. Better tools are undergoing development to monitor disease activity, enabling doctors to tailor treatment precisely.
• Enhanced Diagnostic Screening: Researchers are pinpointing the underlying causes of JIA for earlier diagnosis and identifying children at higher risk. The development of biomarkers (indicators in blood or joint fluid) could lead to detection even before symptoms appear^[12].

Prognosis and Living with JIA

The prognosis for children with JIA varies depending on the type and severity of the disease. Some children may experience periods of remission, where they have no symptoms, while others may have ongoing symptoms of a higher severity.

Prompt diagnosis and aggressive treatment significantly improve the chances of long-term remission and prevent complications.

Recommendations for managing symptoms of JIA include:

• Balanced diet: Focus on anti-inflammatory foods, including fruits, vegetables, and whole grains.^[13]
• Regular exercise: Important for joint health and overall well-being. Physical therapists can help design age-appropriate exercise programs.
• Sufficient sleep: Rest is key for managing pain and fatigue.
• Stress management techniques: Mindfulness, relaxation exercises, and deep breathing can help.
• Counseling or support groups: These can offer a safe space to address emotional challenges like pain, frustration, anxiety, and depression, which are common with JIA.
• Follow treatment plans: Do not miss doctor's appointments and take prescription drugs as directed.
• Frequent monitoring: Helps the doctor track progress, address any issues, and adjust treatment if needed.

Juvenile Idiopathic Arthritis Life Expectancy

JIA does not affect life expectancy in most cases^[14]. However, some complications of JIA, such as inflammation of the heart or lungs, can be life-threatening if left untreated.

Will Children Recover from JIA?

While there is no cure for JIA, many children with the condition can lead active, fulfilling lives with proper treatment and management. With advancements in medical technology and research, the outlook for children with JIA is continually improving.

How can Juvenile Rheumatoid Arthritis be Prevented?

As the exact cause of JIA is still unknown, there is no known way to prevent it. However, early detection and therapy can minimize joint damage and enhance the child's quality of life. If the child is suspected to have a higher risk profile for developing JIA, the lifestyle modifications discussed above may help lower the risk of contracting the condition.

Conclusion

Juvenile Idiopathic Arthritis (JIA) is a chronic autoimmune disease that affects children and adolescents. It can significantly impact their daily activities. With appropriate treatment and management, many children with JIA can lead active, fulfilling lives. With ongoing research and advancements in medical technology, the outlook for children with JIA is continually improving. If your child is experiencing joint pain, stiffness, or other symptoms, it is essential to consult a doctor for proper diagnosis and treatment.

Show All ▼

 

Disclaimer