Most people think of arthritis as a problem for older adults, when decades of wear and tear cause joint pain. However, more than 300,000 children in the U.S. also have arthritis, making it more common than cerebral palsy.
Juvenile idiopathic arthritis is a chronic autoimmune or inflammatory condition that results in some of the same joint symptoms that adults with rheumatoid arthritis suffer. It occurs in children under age 16. With proper modern medical care, most children with JIA lead full active lives. In some cases, a child’s arthritis can even go into long-term remission, with no symptoms and no ongoing medication needed. However, because juvenile arthritis can damage a child’s joints, management by a rheumatology team is important.
An overactive immune system causes JIA, resulting in inflammation of the lining of a joint or joints called the synovium; this inflammation is termed synovitis. The trigger that sets off the overactivity of the immune system is not known. JIA is not directly inherited, but some families carry a risk of developing autoimmune diseases.
A child’s arthritis symptoms can vary. A toddler might not want to walk in the morning, but then could be happily running around by afternoon. A parent might first notice a swollen knee or a limp in a younger child who otherwise is well. Often, young children experience no pain with their arthritis.
Unlike pain associated with an injury or overuse, arthritic pain in children may appear in multiple different joints of the body at the same time. Fever unaccompanied by typical flu or cold symptoms is another clue for some types of juvenile arthritis.
Because no single test can confirm a diagnosis of juvenile arthritis, it’s important to schedule a complete exam and medical history with a physician who is knowledgeable about JIA. Symptoms and treatments vary considerably, depending on the type of arthritis involved.
JIA can take on several forms:
■ Oligoarticular arthritis involves four or fewer joints, usually large joints such as the knee.
■ Enthesopathy associated arthritis involves the points at which tendons and ligaments attach to bones, rather than the joints themselves, and often involves the spine.
■ Polyarticular arthritis looks the most like adult rheumatoid arthritis, with multiple swollen joints.
■ Psoriatic arthritis is related to the common skin condition psoriasis. Children often show arthritic symptoms for five to 10 years before the psoriasis rash appears.
■ Systemic juvenile arthritis often presents with fever and a rash in addition to joint pain and inflammation. System-wide inflammation can involve the liver and the clotting system. In about half these children, symptoms disappear within a year and never return. In the other children, long-lasting arthritis must be managed by the child’s rheumatology team.
Some children who have juvenile arthritis can have hidden or silent inflammation in their eyes, called uveitis or iritis, which can cause permanent vision loss if not caught early and treated. To a parent, the child’s eyes will appear normal, so it’s important to have an examination by an ophthalmologist to detect inflammation related to JIA before it can damage the patient’s vision.
Treatment for juvenile arthritis has advanced tremendously, from just aspirin and steroids in the 1960s to an entire toolbox of medications and innovative approaches that relieve symptoms and prevent damage for many patients. Today’s therapies include:
■ Non-steroidal anti-inflammatory drugs
New versions block inflammation with potentially fewer side effects.
■ Disease-modifying drugs
One of the most commonly used is methotrexate, which can treat eye inflammation as well as inflammation in the joints and sometimes throughout the system.
■ Biologics
These therapies are designed to mimic our naturally occurring immune system molecule blockers and hence control inflammation.
■ Joint injections
Steroid injections into affected joints can produce remission for up to two years and help limbs to grow normally as a child with JIA gets older.
As research continues into juvenile arthritis and JIA treatments, more and better therapies will become available for children with arthritis. The goal of all treatments is to relieve inflammation, control pain and improve the child’s quality of life. About three-quarters of children with JIA will need to be managed by a rheumatologist into adulthood, yet almost all have healthy outcomes.
Learning a child has juvenile arthritis can be scary sometimes. However, most patients are essentially healthy children who happen to have manageable arthritis. Kids with JIA enjoy their childhood much the same as their peers do.
Dr. Barbara Ostrov is board-certified in both pediatric and adult rheumatology. She practices with Penn State Medical Group.
