Juvenile arthritis

About juvenile arthritis

Information about juvenile arthritis is presented here under two headings:

A general overview
Symptoms, types and treatments

For more details about JIA, its treatment, tests, and home and school management see our My JIA booklet here

GENERAL OVERVIEW

The bad news

Juvenile arthritis is a serious and painful autoimmune disease with the potential to cause joint deformities and loss of vision if not diagnosed early and treated effectively. Its proper name is juvenile idiopathic arthritis (JIA). It is classified as a childhood rheumatic disease (CRD) and accounts for about 80% of all CRDs. JIA is one of the commonest chronic childhood diseases affecting 6,000 – 10,000 children in Australia. That’s about 1-2 in a thousand children under the age of 16yrs.

The good news

With early diagnosis and appropriate treatment of JIA by expert paediatric rheumatology teams, permanent joint and eye damage can be prevented or greatly reduced and the likelihood of remission is considerably increased.

Newer and better medications are increasingly available and are making a big difference in reducing joint and eye inflammation and damage.

About half of all children with JIA ‘grow out of it’ as they approach adulthood and go into essentially permanent remission.

Some other facts about JIA and current services

JIA is not rare – its prevalence is similar to other serious childhood diseases such as diabetes yet awareness of it is low, even among health professionals.

It takes 10 months from the onset of symptoms to diagnosis of JIA and sometimes takes much longer.

JIA and CRDs require specialist treatment and care by multidisciplinary teams of paediatric rheumatology doctors, nurses and allied health professionals, and uveitis specialists.

There are only six paediatric rheumatology teams in the whole of Australia and none at all in Tasmania, the ACT and Northern Territory.

Because JIA and CRDs have been historically under-recognised and under-funded there is virtually no accurate data on their prevalence, incidence, or their physical, mental, emotional and economic impacts or outcomes.

JAFA is working hard to remedy the lack of evidence about JIA and CRDs, and to increase paediatric rheumatology services. You can help by:

- Enrolling your child in the Australian Juvenile Arthritis Registry (AJAR)
- Writing to your local Member of Parliament and asking them to support increased funding for paediatric rheumatology teams.

Enrol in AJAR

SYMPTOMS, TYPES AND TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS

JIA is an inflammatory, autoimmune disease that affects the joints and sometimes the eyes, internal organs, and muscles, and is:

diagnosed in children from 0 to 16yrs of age
chronic ie continues for a long time.

SYMPTOMS OF JIA

Symptoms of JIA can include the following but keep in mind that everyone is different and not all children will have all these symptoms:

swelling and redness in the affected joint or joints
the affected joint or joints may be warmer than normal
joint stiffness, especially first thing in the morning
pain (affected joints are usually but not always painful)
pain that may vary from day to day or even from one time of day to another eg may be

painful in the morning but not in the afternoon

Some children may also have:

a persistent or intermittent rash
a fever that comes and goes, often spiking at around the same time of day
fatigue that is not improved by sleep

For a small number of children, the only sign that they have JIA could be uveitis – an inflammatory eye condition.

UVEITIS

In some children, JIA is associated with an inflammatory eye condition called uveitis. If untreated, uveitis can lead to loss of vision so it is critically important that all children with JIA have their eyes checked regularly. These eye checks are particularly important in very young children as they cannot tell their parents or carers that their vision is changing.

The symptoms of uveitis may include:

dry and/or red eyes
discomfort or pain
sensitivity to light
difficulty seeing properly.

There may also be other symptoms. Most importantly, there may be no symptoms making it vital for the child to have regular eye checks even if their eyes feel OK.

MAIN TYPES OF JIA

Oligoarticular JIA

Also known as ‘oligo JIA’, this is the most common type of JIA where 4 or fewer joints are affected in the first six months. In some children, it may spread to involve more joints (this is called ‘extended oligo JIA’). It is more common in girls and often begins in children under 5 years). Oligo JIA carries a risk of developing uveitis (inflammation of the eye).

Enthesitis-related arthritis

Also known as ERA, in this type of JIA, the inflammation occurs where the tendons attach to the bone. Children with ERA often have pain in the spine and hips.

Systemic-onset JIA

Around 1 in 10 children with JIA have systemic-onset JIA (also known as SJIA). Children with SJIA usually have a non-contagious fever and rash. TheInflammation sometimes affects other parts of the body including the heart, liver and lungs as well as joints.

Polyarticular JIA

Also known as ‘poly JIA’, this is where 5 or more joints are affected in the first six months. This type of JIA is divided into 2 groups, rheumatoid factor(RF) negative or RF positive. Most children with poly JIA are RF negative. A small number are RF positive, more likely in teenage girls and sometimes early onset adult rheumatoid arthritis.

Psoriatic arthritis

In this type of JIA, children may have a dry scaly rash (psoriasis), or may have a relative with psoriasis. They may also have changes to their nails, which looks like pitting.

Undifferentiated arthritis

This is where the arthritis does not fit neatly into any of the other categories. Arthritis can be part of other inflammatory diseases or post infection illness.

Reproduced from My JIA with permission of Juvenile Arthritis Research UK.

TREATMENT OF JIA

All treatment for JIA aims to drive the inflammatory process into remission in order to:

prevent joint and eye damage and other complications
reduce and / or prevent pain
optimise mobility, general health and development
enable full participation in home, school, sport and social life

Medications commonly used to treat juvenile arthritis include

TYPE

EXAMPLE

PURPOSE

Pain Medication (analgesics)

Paracetamol

Helps to control mild to moderate pain, and reduce fever. Does not reduce inflammation.

Non-steroidal anti- inflammatory drugs (NSAIDs)

Naproxen
Ibuprofen
Celebrex
Piroxicam

Reduces pain, stiffness and inflammation.

Steroids (corticosteroids)

Prednisolone

Reduces inflammation and eases pain. They usually work quickly and are short- term treatments. May be injected into the affected joint, given orally or by infusion.

Disease-modifying anti-rheumatic drugs (DMARDs)

Methotrexate
Sulfasalazine
Hydroxycholoriquine
Leflunomide

Reduces the immune system which is overactive. They take time to work (weeks or months) and control the disease over the long-term.

Biologics

Etanercept
Adalimumab
Tocilizumab
Abatacept
Rituximab
Tofacitinib
Secukinumab

These target specific chemicals or cells in the immune system. Sometimes given alongside DMARDs.

Non-medical care of JIA includes physiotherapy, occupational therapy, pain management, and psychological adjustment, and self-care education and should be provided by specially trained nurses and allied health professionals (ie physio – and occupational therapists, psychologists, podiatrists).

WHO SHOULD TREAT JIA & CRDS?

ALL children with JIA and other CRDS require assessment, treatment and regular review and monitoring of their condition by a paediatric rheumatologist ie a paediatrician with advanced training in rheumatology. Comprehensive care is best provided by multidisciplinary teams of paediatric rheumatologists, specialist rheumatology nurses, physiotherapists, occupational therapists and psychologists. Children with psoriatic arthritis may need to be seen regularly by a dermatologist.

Uveitis should be treated by a uveitis specialist ie an ophthalmologist with experience and a special interest in treating this condition. Additionally, ALL children with JIA need to have their vision tested and eyes examined regularly.

For more detailed information about JIA, its treatment and home and school management see the My JIA booklet at: LINK

For more details about JIA, its treatment, tests, and home and school management see the My JIA booklet:

Download My JIA