Oligoarthritis

What is oligoarthritis?

Oligoarthritis, also known as oligoarticular juvenile idiopathic arthritis, is the most common type of juvenile idiopathic arthritis (JIA). The condition causes joint inflammation, stiffness and pain in large joints of your body, specifically the knees, ankles and elbows and the middle layer of the eye (uvea).

In Latin, “oligo” means “few.” If you have oligoarthritis, you have fewer than five joints affected with arthritis.

What are the types of oligoarthritis?

There are two types of oligoarthritis based on how many joints are affected over a period of time:

• Persistent oligoarthritis: Four or fewer joints affected with arthritis after six months.
• Extended oligoarthritis: More than four joints affected with arthritis after six months.

Who does oligoarthritis affect?

Oligoarthritis is a juvenile condition that affects children and teenagers. It more commonly affects children assigned female at birth, but anyone can get the condition.

How common is oligoarthritis?

Oligoarthritis is the most popular type of juvenile idiopathic arthritis (JIA). An estimated 4 to 16 in 10,000 children have JIA in North America and Europe. Approximately half of all children with JIA have oligoarthritis. Up to 20% of people diagnosed with oligoarthritis also have uveitis (eye inflammation).

How does oligoarthritis affect my child’s body?

Oligoarthritis is an autoimmune disease. Your child’s immune system defends their body from foreign invaders like viruses, germs and bacteria. When they have an autoimmune disease, their immune system isn’t sure what’s healthy and what’s an invader, so it attacks their body’s cells and tissues in the same way it would attack a virus, which causes symptoms.

In the case of oligoarthritis, your child’s immune system targets the tissue around a joint (synovium) as though the tissue were an invader. Your child’s body normally releases fluid to cushion your joints to facilitate movement. When their immune system attacks their synovium, their body produces more of that fluid, which causes joints to swell or become larger. This swelling causes symptoms of oligoarthritis, making the joint stiff and uncomfortable.

What are the symptoms of oligoarthritis?

Symptoms of oligoarthritis range in severity for each person diagnosed with the condition. Symptoms affect four joints or fewer and could include:

• Blurry vision.
• Fatigue.
• Joint discomfort.
• Joint stiffness.
• Tender or swollen joints.

What causes oligoarthritis?

Oligoarthritis is a type of juvenile idiopathic arthritis. The term “idiopathic” refers to an unknown cause. Some studies suggest that the condition results from a genetic mutation activated by a virus or bacteria, but research is ongoing.

Does oligoarthritis spread to other joints?

In some cases, oligoarthritis can spread to other joints in your body over time. Each case is unique to the person diagnosed with the condition. Not every case of oligoarthritis spreads to other joints, and the condition can range from mild to severe.

How is oligoarthritis diagnosed?

Your child’s healthcare provider will diagnose oligoarthritis after performing a complete medical history, which includes learning about their symptoms, the duration and severity of the symptoms, understanding their medical history and performing a physical exam on the affected joints. Your physician’s exam focuses on ruling out conditions with similar symptoms leading to your child’s diagnosis.

To confirm the diagnosis, your physician might order imaging tests like an X-ray or an MRI to see the affected joints. They might also order a laboratory test like urine, blood or joint fluid test to determine what is causing your child’s symptoms.

If symptoms affect your child’s vision, your physician will recommend they see an ophthalmologist for an eye exam to check for inflammation of the eye (uveitis).

How is oligoarthritis treated?

Treatment for oligoarthritis addresses symptoms to reduce inflammation, prevent joint damage and increase joint mobility. Treatment could include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs provide pain relief and reduce joint swelling.
• Corticosteroid (steroids) injection: Your physician may give your child a shot of corticosteroid into the affected joint. Your physician might also prescribe a corticosteroid pill, which they can take by mouth as directed.
• Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs prevent bone and joint damage by stopping the immune system from attacking your child’s joints. DMARDs are a secondary line of defense if injections don’t work or may be used in treatment induction (initial treatment).
• Biologics: Biologic medications may be used for joints not responding to therapy.
• Physical and occupational therapy: Physical and occupational therapy improves mobility by strengthening muscle tone and flexibility. Bracing may aid joints in regaining range of motion and protect your child’s joints as they grow.

Are there side effects of the treatment?

Your child’s provider will monitor the effectiveness of the treatment they prescribe to reduce side effects, especially if your child is taking corticosteroid pills. Long-term corticosteroids can weaken bones and interfere with their normal growth pattern throughout childhood.

NSAIDs can cause an upset stomach or nausea, so your provider will recommend your child take NSAIDs with food to prevent side effects.

How soon after treatment will I feel better?

Depending on the severity of your child’s diagnosis and the effectiveness of treatment, oligoarthritis can last for a few months to years. Symptoms often get less severe and can go away over time with treatment (remission). Sometimes, oligoarthritis spreads to other joints in your child’s body as they grow. Following your provider’s unique treatment plan will improve their recovery.

How can I prevent oligoarthritis?

Since the cause of oligoarthritis is unknown, there's no way to prevent the condition.

What can I expect if I have a child with oligoarthritis?

Oligoarthritis affects the joints in your child’s body, which could make it difficult for them to be active like other children their age, especially without treatment. Most children outgrow the condition as they enter adulthood. Some children will experience more joint discomfort as they age in other parts of their body. Treatment reduces joint pain and stiffness and physical therapy improves your child’s mobility to allow them to move and play without restriction.

When should I see my healthcare provider?

Visit your healthcare provider if your child has trouble moving or experiences joint/extremity discomfort that won’t go away with NSAIDs or medication prescribed to treat your child’s condition. If your child has trouble seeing or has eye pain or ongoing redness, visit your optometrist for an eye exam.

What questions should I ask my doctor?

• Are there side effects to the treatment you prescribed to my child?
• How many corticosteroid injections does my child need to feel better?
• How often should my child visit a physical therapist?
• Can my child play sports if they have oligoarthritis?

What is the difference between oligoarthritis and polyarthritis?

Oligoarthritis and polyarthritis are both types of juvenile idiopathic arthritis. The difference between both conditions is that oligoarthritis affects fewer than five joints, most often the large joints like the knees, ankles and elbows and polyarthritis affect five joints or more, and more often smaller joints in the hands and feet.

A note from Cleveland Clinic

Juvenile idiopathic arthritis is common and could last a long time, but that doesn’t mean it’ll take over your child’s life. Even with an oligoarthritis diagnosis, your child should still be able to participate in activities and play sports with other children their age. Work closely with your child’s healthcare provider to follow a treatment plan unique to your child’s needs to help them stay active as they grow.