Juvenile Idiopathic Arthritis (JIA)

What is juvenile idiopathic arthritis?

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that affects children. It’s chronic (long-lasting) and can affect joints in any part of your child’s body.

JIA is an autoimmune disease in which your child’s immune system mistakenly targets the synovium (the tissue that lines the inside of the joint) and the synovial fluid in the joint. This causes the synovium to make extra fluid, which leads to swelling, pain and joint stiffness.

This immune response and related inflammation can affect nearby tissues, eventually damaging cartilage and bone. The inflammation can also affect other areas of your child’s body, especially their eyes. Left untreated, JIA can interfere with your child’s normal growth and development. But treatment can significantly improve their overall quality of life.

JIA is the most common type of arthritis in children. It affects about 1 in 1,000 children (about 300,000 children total) in the United States.

Types of juvenile idiopathic arthritis

There are several subtypes of JIA, depending on the symptoms and the number of joints involved:

Oligoarticular juvenile idiopathic arthritis

Also called oligoarthritis, this type of JIA affects fewer than five joints, most often in a child’s knee, ankle and elbow. It also can cause uveitis, an inflammation of the middle layer of the eye (the uvea). Uveitis may be undetectable without a dedicated eye exam. About half of all children with JIA have oligoarthritis. It’s more common in females. Many children outgrow oligoarthritis by adulthood. In some children, it can involve more joints.

Polyarticular juvenile idiopathic arthritis

This type of JIA, also called polyarthritis, affects five or more joints, often the same joints on both sides of a child’s body. Polyarthritis can also affect the neck and jaw joints and smaller joints, like those in the hands and feet. It’s more common in females and accounts for 20% of JIA cases.

Psoriatic juvenile idiopathic arthritis

Also known as psoriatic arthritis, this is when a child has both arthritis and psoriasis (a skin rash that causes raised, red patches or skin lesions covered with a silvery-white buildup of dead skin cells). Psoriatic arthritis can also be diagnosed even if a child doesn’t have psoriasis but has other features like a swollen finger or toe, certain nail changes, or a first-degree relative with psoriasis.

Juvenile spondyloarthritis

This type of arthritis, also called axial spondyloarthritis, affects a child’s spine, hips and entheses (the points where tendons and ligaments attach to bones). Their eyes may also become painful or red. Juvenile spondyloarthritis occurs mainly in males over the age of 7.

Systemic juvenile idiopathic arthritis

Sometimes called juvenile Still’s disease, this type occurs in about 10% to 20% of children with JIA. A systemic illness is one that may affect a child’s entire body or many body systems. Besides arthritis, systemic JIA usually causes persistent high fever and a rash, which most often appears on the trunk, arms and legs when fever spikes. It can also affect internal organs like the heart, liver, spleen and lymph nodes. This type of JIA rarely affects the eyes. It occurs equally in males and females.

What are the symptoms of juvenile idiopathic arthritis?

Juvenile idiopathic arthritis symptoms vary depending on the type and may include:

• Eye redness, eye pain and blurred vision
• Fatigue or irritability
• Fever
• Limping
• Morning joint stiffness
• Pain, swelling or warmth in your child’s joints
• Skin rash
• Swollen lymph nodes
• Weight loss or poor growth

What causes juvenile idiopathic arthritis?

Experts don’t yet know what causes JIA. In fact, the term “idiopathic” means “unknown cause.” Possible contributing factors may include:

• Environmental factors that influence your child’s immune system
• Genetics
• Infection

What are the complications of juvenile idiopathic arthritis?

Left untreated, JIA can lead to:

• Chronic (long-term) arthritis and loss of function
• Inflammation of the membranes surrounding the heart (pericarditis) or lungs (pleuritis)
• Interference with your child’s bones and growth
• Permanent joint damage
• Vision issues, including uveitis (inflammation inside the eye) and uveitis-related vision loss

How is juvenile idiopathic arthritis diagnosed?

A healthcare provider will:

• Do a physical examination of your child’s joints
• Review your child’s medical history
• Talk with you and your child about their symptoms

Because there are no blood tests to diagnose JIA, your provider will try to rule out other conditions to reach a diagnosis.

They may also order these tests:

• Imaging tests like X-rays, ultrasound or magnetic resonance imaging (MRI) to show the condition of your child’s joints.
• Laboratory tests on blood, urine, and/or joint fluid to help characterize the type of arthritis and rule out other possible causes of your child’s symptoms like infections, injuries or cancer.

How is juvenile idiopathic arthritis treated?

Treatment for JIA usually includes medications and exercise. The goals of treatment are to:

• Increase joint mobility and strength
• Prevent joint damage and complications
• Relieve pain
• Reduce swelling

Medications

If your child receives a JIA diagnosis, your healthcare provider might recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines provide pain relief and reduce swelling, but they don’t affect the course or outcome of JIA.
• Corticosteroids. Providers often give corticosteroid medication as an injection (shot) into a single affected joint. Sometimes, steroids are also given orally (by mouth) as a pill or liquid if many joints are affected or if a child has systemic juvenile idiopathic arthritis.
• Disease-modifying anti-rheumatic drugs (DMARDs). These medications work by changing the actual disease process in arthritis. The aim of DMARD therapy is to suppress an immune attack on your child’s bones and joints.
• Biological modifying agents. These medications target molecules or proteins that cause inflammation. They often recommend this treatment for children with severe symptoms that haven’t improved with other medications.

Exercise

Exercise (including physical and occupational therapy) can help reduce pain, maintain muscle tone, improve mobility (ability to move) and prevent permanent complications. In some cases, a provider might use splints or braces to help protect your child’s joints as they grow.

Can juvenile idiopathic arthritis be prevented?

Because healthcare providers don’t currently know what causes JIA, there’s no method to prevent it from developing. Experts continue to research the cause and prevention of JIA.

What’s the outlook for kids and teens with juvenile idiopathic arthritis?

JIA affects each child differently. For some, it affects one or two joints, and the disease is easy to manage. For others, JIA may involve many joints and cause more severe or longer-lasting symptoms.

With early detection and treatment, it’s possible to manage the arthritis, prevent joint damage, and allow normal or near-normal function for most children with JIA.

How long does juvenile idiopathic arthritis last?

JIA can last for months or years. Some children go into full remission, while others still have active symptoms into adulthood. Providers call this “aging out” of JIA and into adult arthritis. There’s really no way to predict whether this will happen. But your healthcare provider can help manage your child’s condition, find effective treatments and set them up for success in the future.

When should I see my healthcare provider?

You should schedule an appointment with a healthcare provider if your child has these symptoms for six weeks or longer:

• Joint pain
• Stiffness
• Swelling around their joints

What are some tips for kids and teens living with juvenile idiopathic arthritis?

If your child has JIA, encourage them to live life as normally as possible. It’s important for them to attend school, play sports, and participate in extracurricular and family activities regularly. Providers sometimes recommend special accommodations at school to help children with arthritis-related limitations.

It’s important to know that exercise doesn’t make symptoms of arthritis worse. In fact, exercise can help prevent deconditioning (changes in your child’s body that happen during periods of inactivity) and increase muscle strength and endurance to support their joints.

As far as nutritional needs, there’s no evidence to suggest that specific eating plans help arthritis symptoms. So, encourage your child to eat a standard, well-balanced diet.