Arthritis is inflammation of the joints that may cause swelling and pain. However, it may be associated with systemic disease with involvement of other organs.
It may start with a swollen knee or knuckle, a spiking fever, or an unexplained rash. But no matter what symptoms appear, hearing the word “arthritis” in a diagnosis for your child can be unexpected and scary. There are many causes of arthritis but JIA is the most common condition causing arthritis in the developed/western world.
So, what is Juvenile Idiopathic Arthritis?
Juvenile idiopathic arthritis commonly known as JIA, is a form of arthritis in children that affects one or more joints for at least 6 weeks in a child 16 years old or younger. Children often outgrow JIA, but if untreated it may result in permanent joint contractures leading to significant disabilities. It also can affect bone development in a growing child that causing leg length discrepancies. There are several subtypes of JIA as it does manifest in the first 6 months.
What are the different subtypes of JIA?
- Systemic onset JIA: This type affects one or more joints. There is often a high fever and a skin rash. It may also cause inflammation of internal organs, including the heart, liver, spleen, and lymph nodes. It is the least common type. It affects 1 in 10 to about 1 in 7 children with JIA.
- Oligoarticular JIA: This type affects 1 to 4 joints (usually large joints) in the first 6 months of disease. If no more joints are affected after 6 months, this type is called persistent. If more joints are affected after 6 months, it is called extended.
- Polyarticular JIA: This type affects 5 or more joints (small and large joints) in the first 6 months of disease. Blood tests will show negative rheumatoid factor (RF) in more than two thirds of patients in his group, and RF negative in less than one third.
- Enthesitis-related JIA: With this type, a child has arthritis as well as enthesitis. This is an inflammation with swelling of the tissue where bone meets a tendon or ligament such as the Achilles tendon. It often affects the hips, knees, and feet and can cause spondylo-arthritis such as ankylosing spondylitis in adulthood.
- Psoriatic arthritis: With this subtype, a child may have both arthritis and a red, scaly skin disease called psoriasis. Or a child may have arthritis and 2 or more of the following:
- Inflammation of a finger or toe
- Pits or ridges in fingernails
- A first-degree relative with psoriasis
- Undifferentiated arthritis. This is arthritis that has symptoms of 2 or more JIA types above. Or the symptoms might not match any subtype of JIA.
What causes juvenile idiopathic arthritis?
JIA is an autoimmune disease. JIA is causes by:
- Genes; JIA is lined to part of a gene called HLA antigen DR4 and others such as HLA B27. A person with this antigen may be more likely to have the disease.
- Environment (can be trigged by exposure to certain things)
What are the symptoms?
The first signs often are joint pain or swelling or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.
Symptoms may appear during episodes (flare-ups). Or they may be ongoing (chronic). Each child’s symptoms can vary. Some of the most common symptoms include:
- Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints, often in the morning or after a nap
- Eye inflammation known as iritis or anterior uveitis
- Warmth and redness in a joint
- Less ability to use one or more joints
- Decreased appetite, poor weight gain, and slow growth
- High fever and rash (in systemic JIA)
- Swollen lymph nodes (in systemic JIA)
These symptoms can seem like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How is Juvenile Idiopathic Arthritis Diagnosed?
JIA is based on the clinical ground of symptoms of joint inflammation that has occurred for 6 weeks or more. There are no diagnostic test/tests for JIA, but certain tests may support the diagnosis, and help to rule out other conditions such as leukemia, and other rheumatic diseases such as lupus.
These include blood tests such as:
- Antinuclear antibody (ANA) and other antibody tests. These tests measure blood levels of antibodies that are often seen in people with rheumatic disease.
- Complete blood count (CBC).This test checks for low counts of red blood cells, white blood cells, and platelets.
- Complement test. This test is done to measure the level of complement. This is a group of proteins in the blood that helps destroy foreign substances. Low levels of complement in the blood are linked to immune disorders.
- Erythrocyte sedimentation rate (ESR or sed rate).This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- C-reactive protein (CRP).This protein shows up when inflammation is found in the body. ESR and CRP show similar amounts of inflammation. But one may be high when the other is not. This test may be repeated to check a child’s response to medicine.
- Creatinine. This is a blood test to check for kidney disease.
- Hematocrit. This measures the number of red blood cells in a blood sample. Low levels of red blood cells (anemia) are common in people with inflammatory arthritis and rheumatic diseases.
- Rheumatoid factor (RF).This test checks to see if RF is in the blood. This is an antibody found in the blood of most people who have rheumatoid arthritis and other rheumatic diseases.
- White blood cell count. This measures the number of white blood cells in the blood. Higher levels of white blood cells may mean an infection. Lower levels may be a sign of some rheumatic diseases or a reaction to medicine.
Your child may also have imaging tests. These can show how much damage the bones have. The tests may include:
- X-rays. This test uses a small amount of radiation to make images of organs, bones, and other tissues.
- CT scan. This uses a series of X-rays and a computer to make detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
- MRI. This test uses large magnets and a computer to make detailed pictures of organs and structures in the body.
- Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.
Other tests may include:
- Urine tests. These look for blood or protein in the urine. This can mean the kidneys are not working normally.
- Joint aspiration (arthrocentesis).A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
How is Juvenile Idiopathic Arthritis Treated?
Treatment may include medicines and lifestyle changes such as:
- Nonsteroidal anti-inflammatory medicines (NSAIDs), to reduce pain and inflammation
- Disease-modifying antirheumatic medicines (DMARDs), such as methotrexate, to ease inflammation and control JIA
- Corticosteroid medicines, to reduce inflammation and severe symptoms
- Medicines called biologics that interfere with the body’s inflammatory response. They are used if other treatment isn’t working.
- Physical therapy, to improve and maintain muscle and joint function
- Occupational therapy, to improve the ability to do activities of daily living
- Nutrition counseling
- Regular eye exams to find early eye changes from inflammation
- Regular exercise and weight control
- Getting enough rest
- Learning to use large joints instead of small joints to move or carry things
Are there any complications?
Nearly half of all children with JIA recover fully. Others may have symptoms for years. Some will have rashes and fever. Some patients may have arthritis that gets worse and develops joint contractures. Others may have problems that include slow growth and thinning bones (osteoporosis), and eye complications. In rare cases, there may be problems with the kidneys, heart, or endocrine system.
You can help your child live with juvenile idiopathic arthritis by sticking to a treatment plan and seeking support groups for your child to be around other children with JIA.
Come see us, we’re here to help’
Make an appointment with one of our specialists for any questions or concerns you may have regarding JIA. Click here to find a doctor>>
About Dr. Abraham Gedalia
Dr. Abraham Gedalia specializes in Pediatric Rheumatology at Children’s Hospital. With more than 35 years of experience, he is certified by the American Board of Pediatrics in both Pediatrics and Pediatric Rheumatology. Dr. Gedalia received his medical degree from the Hebrew University School of Medicine in Jerusalem. He then completed his residency training at the University of Rochester in New York and fellowship training in Pediatric Rheumatology at Baylor College of Medicine in Houston. Dr. Gedalia serves as a Professor of Pediatrics and Pediatric Rheumatology at LSU Health New Orleans. On why he continues to practice medicine, Dr. Gedalia said, “I like what I do and above all I want to stay active and use my expertise to benefit the kids in our community.” In addition to seeing patients at Children’s Hospital’s Main Campus in New Orleans, Dr. Gedalia also sees patients in Metairie, Baton Rouge and Lafayette, and is fluent in English and Hebrew.