Juvenile Idiopathic Arthritis

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KEY POINTS

• Juvenile idiopathic arthritis (JIA) is a disease that causes pain, stiffness, swelling, and loss of movement of the joints. It is the most common form of arthritis in children.
• The goal of treatment is to relieve pain and reduce joint swelling. Many medicines for JIA that can lessen swelling and pain or slow down or stop damage to the joints including NSAIDs, steroids, and DMARDs.
• Follow the full course of treatment prescribed by your healthcare provider. Let all of your child’s healthcare providers know what medicines your child is taking, especially if your child is going to have surgery.

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What is juvenile idiopathic arthritis?

Juvenile idiopathic arthritis (JIA) is a disease that causes pain, stiffness, swelling, and loss of movement of the joints. It is the most common form of arthritis in children. It is also called juvenile rheumatoid arthritis. Many children with this disease have a mild form and few problems. However, some forms of this disease can produce long-term problems.

There are at least 5 types of JIA:

• Four or fewer joints, such as the larger joints in the hips, knees, shoulders, and elbows are affected. Your child may also have swelling and irritation of the eyes. This is the most common type of JIA.
• Five or more joints may be affected, including smaller joints, like those in the hands and feet.
• Joints, lymph nodes, and organs such as the heart, liver, and spleen may be affected.
• Joints are affected with a skin disorder called psoriasis, or a family history of psoriasis, or other conditions affecting the fingers or nails.
• Joints are affected along with swelling and inflammation where tendons and ligaments attach to the bone.

Your child may have just 1 attack, but more often the symptoms come and go. Repeated attacks can lead to permanent joint damage. However, you can relieve symptoms and prevent or slow down joint damage by following your child’s treatment plan. The outlook for JIA is often better than for an adult with arthritis. Many children with JIA outgrow the arthritis and recover completely by adulthood.

What is the cause?

The exact cause of JIA is not known. It appears to be an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. When your child has JIA, the attack is mostly against the tissues that line the joints. The tissues get inflamed, causing pain, swelling, and stiffness. The inflammation also damages bone and cartilage (the cushioning in joints) and can change the shape of your child’s joints.

Things that may cause or contribute to JIA are:

• Genes your child has inherited. Genes are inside each cell of the body and are passed from parents to children. They contain the information that tells the body how to develop and work.
• Infection, such as infection with the Epstein-Barr virus or rubella (German measles) virus

What are the symptoms?

Symptoms may include:

• Joints that are red, tender, warm, and swollen
• Joint pain and stiffness that last 1 hour or longer, especially in the morning or after a rest
• Joint pain on both sides of your child’s body that may be more severe on one side
• Changes in the shape of your child’s joints over time
• Mild fever, feeling tired, or generally not feeling well
• Small lumps under the skin near affected joints

The first symptoms of JIA may be fever and chills and a light pink rash. Get medical help for your child right away if he has redness on the front part of the eyes and painful sensitivity to light. These may be symptoms of a serious complication of JIA called uveitis.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Tests may include:

• Rheumatoid factor test, a test for substances called CCP antibodies, and other blood tests
• X-rays
• Joint aspiration, which uses a needle to take fluid from a joint for testing

Your child may have more tests to check for other possible causes of the symptoms. Your provider may refer your child to a rheumatologist, a doctor who specializes in treating diseases like JIA.

How is it treated?

The goals of treatment are to:

• Relieve pain and stiffness
• Reduce swelling
• Keep the shape of the joints as normal as possible, so they move well and so that your child can do his usual activities
• Stop or slow down damage to the joints

There are many medicines for JIA that can lessen swelling and pain or slow down or stop damage to the joints.

• Many children with JIA take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. Read the label and give as directed. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome.
• Steroids may be used to reduce severe pain and swelling. These medicines are effective but can have serious side effects, such as interfering with normal growth.
• Disease-modifying antirheumatic drugs (DMARDs) slow down or stop damage to the joints. They can help lessen pain and inflammation in the joints. DMARDs may increase the risk of infection or other serious side effects. Your child’s healthcare provider will check your child regularly to see how these medicines are working and watch for any side effects.
• Medicines that block a protein called TNF are used to treat some children with severe JIA. These medicines are given by injection. Some children have had serious side effects while using these medicines.

Discuss the risks, benefits, and costs of your child’s medicines with your healthcare provider.

JIA may cause abnormal bone growth. Also, if your child avoids using a painful joint, the lack of movement can weaken and shorten muscles. Physical therapy can help your child have better use of joints and muscles. Your child’s physical therapist will prescribe exercises and the right amount of activity for your child. Sometimes it may help to use a splint or brace to rest a joint and protect it from injury.

Your child's provider may advise arthroscopy, which is a type of surgery done with a small scope inserted into the joint. The provider can look directly at the joint and sometimes do small repairs of the joint without having to cut open the joint.

How can I take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the sore joint every 3 to 4 hours for up to 20 minutes at a time.
• Moist heat may help relieve pain, relax the area, and make it easier to move the joint. Put moist heat on the sore area for up to 30 minutes to relieve pain. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a warm wet washcloth, or a hot shower. To prevent burns to your skin, follow directions on the package and do not allow your child to lie on any type of hot pad. Don’t use heat if your child has swelling or a rash.
• Take your child to the eye doctor once a year for regular eye exams.
• Take your child to the dentist every 6 months. Medicines for JIA may affect your child's teeth.
• Give your child a healthy, diet. Your child should try to maintain a healthy weight. If your child is overweight, losing some weight may reduce the pain and stress on joints.
• Make sure that your child stays active and keeps his muscles and joints strong and mobile. Walking, bicycling, and swimming may be good activities. Your child should learn to warm up before exercising. Talk to your child’s healthcare provider or physical therapist about exercises your child can do when he is having pain.
• Find a support group or get counseling for your child.
• Be sure to let all of your child’s healthcare providers know what medicines your child is taking, especially if your child is going to have surgery.

Ask your child’s healthcare provider:

• How and when you will get your child’s test results
• How long it will take your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for checkups. Keep all appointments for provider visits or tests.