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Juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a condition that affects children. There are three main types and it can affect both boys and girls of any age.

The symptoms may last into adult life or they may disappear as the child grows up. Juvenile idiopathic arthritis can be treated with a number of medicines, although there is no cure.

  • About juvenile idiopathic arthritis
  • Symptoms
  • Complications
  • Causes
  • Diagnosis
  • Treatment
  • Living with juvenile idiopathic arthritis
  • Further information
  • Sources
  • Related topics

About juvenile idiopathic arthritis

Juvenile idiopathic arthritis (also known as juvenile rheumatoid arthritis and juvenile chronic arthritis) is a condition that can affect children of any age. It affects approximately one in 1,000 children in the UK; in all about 12,000 children under the age of 16 are affected by some form of arthritis. Arthritis means inflammation of the joints but in juvenile idiopathic arthritis there may also be inflammation of the eyes and internal organs. Juvenile idiopathic arthritis is a chronic condition - this means that it lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not to how serious a condition is.

There are a number of types of juvenile idiopathic arthritis - the three main ones are listed here.

  • Oligoarticular (or pauciarticular) juvenile arthritis affects about half of all children who have the condition.
  • Just under a third of children who have juvenile idiopathic arthritis have a form called polyarticular.
  • The least common form of the condition is systemic juvenile idiopathic arthritis (also known as Still's disease). About one in five children with the condition have this type.

Symptoms

Juvenile idiopathic arthritis affects all children differently. Symptoms may come and go over time with periods when they flare up and are worse. There may also be times when your child has no symptoms at all - this is called remission.

Inflammation of the joints causes the main symptoms of all types of juvenile idiopathic arthritis, with your child's joints becoming swollen and painful or stiff. The joints may also look red and feel hot when you touch them. The number of joints that are affected will vary depending on which form of the condition your child has. There are other symptoms that are specific to certain types of juvenile idiopathic arthritis.

Oligoarticular juvenile idiopathic arthritis

This type of juvenile idiopathic arthritis mostly affects girls under the age of eight. It affects four joints or fewer, usually the larger ones such as the knees, ankles or wrists. After the age of eight, boys are more likely to develop this type of the condition when it may lead to stiffness in their neck and lower back as they grow up.

Polyarticular juvenile idiopathic arthritis

Your child may develop polyarticular juvenile arthritis at any age - he/she may even be only a few months old. This condition affects five or more joints, especially those in your child's hands and feet such as his/her fingers and toes. However, inflammation may also occur in your child's hips, neck and jaw. It can spread from joint to joint, often very quickly, but it may also start suddenly in a number of joints at the same time.

Other symptoms that your child may have with polyarticular juvenile arthritis include:

  • nodules on his/her elbows
  • rash
  • fever

Systemic juvenile idiopathic arthritis

Both boys and girls are affected equally by this type of juvenile idiopathic arthritis and it may develop at any age.

If your child has this type of juvenile idiopathic arthritis, as well as joint pain his/her first symptoms may include:

  • rash
  • fever
  • swollen glands
  • tiredness and lack of energy
  • weight loss

The symptoms may come and go quite suddenly.

As these are different from the usual symptoms of arthritis, you and your doctors may initially think your child has an infection.

This type of juvenile idiopathic arthritis can also lead to inflammation of your child's internal organs such as the liver or spleen.

Complications

There are complications associated with some types of juvenile idiopathic arthritis.

If your child has oligoarticular juvenile idiopathic arthritis, there is a risk that he/she may develop inflammation of the eyes. This is called uveitis. One or both eyes may be red and sore, but usually there are no symptoms, even if your child's eyes are inflamed inside. Uveitis can cause blurred vision and it may lead to blindness if it isn't found and treated early enough. It's important that your child has regular eye checks with an ophthalmologist (a doctor specialising in identifying and treating eye conditions), even if he/she doesn't have any obvious symptoms.

Systemic juvenile idiopathic arthritis may cause inflammation of your child's internal organs. Occasionally this can include the tissue that covers the heart and lead to a condition called pericarditis. This can affect how well your child's heart functions.

All types of juvenile idiopathic arthritis may affect your child's general growth. It's possible that his/her affected limbs may develop at different rates, leading to them being slightly different lengths.

Causes

The exact reasons why your child may develop juvenile idiopathic arthritis aren't fully understood at present but it's thought to be an autoimmune disease. This means that an unusual reaction from your immune system causes damage to your body. It's possible that the tendency to develop the condition is inherited. However, it's thought that other factors are likely to be involved which are responsible for setting off this reaction of your child's immune system.

Diagnosis

Your GP will ask about your child's symptoms and examine him/her. Your doctor may also ask you about your child's medical history. There is no single test that can diagnose juvenile idiopathic arthritis and your GP will want to rule out other conditions that may be causing your child's symptoms. Juvenile idiopathic arthritis can be difficult to diagnose as the symptoms can come and go quickly, and at first your child may not have any obvious signs of joint inflammation.

It's possible that your GP will want to wait a few months to see how your child's symptoms develop. This may be difficult for both you and your child, but it may be necessary so that a more definite diagnosis can be made.

Your child may be referred for further tests. These may include:

  • a blood test to show if there is inflammation
  • a blood test for a marker called rheumatoid factor - this may be present if your child has polyarticular juvenile idiopathic arthritis
  • other blood tests
  • X-rays
  • an MRI scan - this uses magnets and radiowaves to produce images of the inside of your child's body
  • an ultrasound scan - this uses sound waves to produce an image of the inside of your child's body
  • an electrocardiogram (ECG) - this measures the electrical activity of your child's heart to see how well it's working

Treatment

There are a number of treatments that can help to reduce the symptoms of juvenile idiopathic arthritis. Some medicines can slow down or even stop the progression of the condition, although there is no cure for it. Your child will receive treatment from a multidisciplinary team which may include:

  • doctors (including your child's GP, paediatricians - doctors specialising in identifying and treating conditions in children - and rheumatologists - doctors specialising in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues)
  • specialist nurses
  • physiotherapists
  • occupational therapists
  • psychologists

Your child will need regular check-ups to observe his/her condition. This is important as juvenile idiopathic arthritis is different in all children and your child may develop new symptoms that need treatment. If your child is taking medicines for their condition, these will also need monitoring.

Self-help

It's very important that your child takes regular exercise, every day if possible. Swimming is very helpful but you should also encourage your child to do weight-bearing exercise such as running or aerobics as this helps to strengthen muscles and joints.

Your child will be given exercises by his/her physiotherapist to do at home. These will aim to reduce the pain and stiffness in your child's joints. Your child will need to do these exercises every day, even though he/she may not feel like it.

Using heat treatments, such as a hot water bottle wrapped in a towel may help to ease painful and swollen joints. A cold compress, such as ice or a bag of frozen peas, wrapped in a towel may also help. You should not apply ice directly to the skin as it can damage your child's skin.

Medicines

There are a number of different types of medicine that can help to reduce your child's symptoms. With all medicines, it's important to always read the patient information leaflet that comes with your medicine and ask your doctor or pharmacist for advice.

  • Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg Nurofen) reduce inflammation and so relieve pain and swelling. For some children with mild juvenile idiopathic arthritis, this may be the only medicine they need to take.
  • If other anti-inflammatory medicines don't help the symptoms, your child may be prescribed steroids such as prednisolone. These work quickly to reduce symptoms of inflammation, but they can have serious side-effects. The most common way of giving steroids is as an injection into the inflamed joint. This works quickly and is very safe and effective. If your child is young or very frightened of injections, he/she may be able to have the injection under a very light and quick general anaesthetic. This means he/she will be asleep during the procedure and feel no pain. This is also a very safe procedure for a child to have.
  • Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate work to slow down the disease process. Your child may have to try a number of DMARDs before finding one that suits him/her. It may take up to three months for these medicines to have an effect.
  • Your child may be eligible to try a medicine called etanercept depending on the type of juvenile idiopathic arthritis he/she has, and if other medicines haven't helped. Etanercept works by blocking the action of a part of the immune system that causes inflammation.

All medicines can have side-effects, some more serious than others. See your doctor if you are concerned about any of your child's symptoms. Your doctor will also assess the possible risks compared with the benefits of any medicines that are given to your child.

Other treatments

There is some evidence that using splints can be helpful for keeping joints in the correct position. They may also help to rest and support a joint. Ask your child's physiotherapist for more information about splints.

Living with juvenile idiopathic arthritis

There is a great deal of support available for children with juvenile idiopathic arthritis and their families. As well as the multidisciplinary team treating your child, there are support groups who can offer advice and information. These may be useful in helping your child to live as normal a life as possible. It's important that you encourage him/her to keep up hobbies and spend time with youngsters of the same age.

Adaptations may need to be made at home and at school to help your child. Your child's occupational therapist will be able to give you more information about this.

Seven out of 10 children who have juvenile idiopathic arthritis will get better and won't have any problems once they reach adulthood, although some may have joint damage that lasts into adult life. It's possible that your child's arthritis will continue as he/she gets older, but it's likely that there will be periods of remission.

Further information

The Children's Chronic Arthritis Association

Arthritis Care

Arthritis Research Campaign

Sources

  • Juvenile rheumatoid arthritis. Lab Tests Online UK. www.labtestsonline.org.uk, accessed 18 January 2008
  • Arthritis in children. Arthritis Care. www.arthritiscare.org.uk, accessed 18 January 2008
  • Arthritis. A guide for teenagers. Arthritis Research Campaign. www.arc.org.uk, accessed 18 January 2008
  • Juvenile idiopathic arthritis. National Rheumatoid Arthritis Society. www.rheumatoid.org.uk, accessed 22 January 20008
  • When your child has arthritis. Arthritis Research Campaign. www.arc.org.uk, accessed 23 January 2008
  • Physiotherapy. The Children's Chronic Arthritis Association. www.ccaa.org.uk, accessed 23 January 2008
  • British National Formulary for Children, Non-steroidal anti-inflammatory drugs. Vol. 54: BMJ Publishing Group, 2007:564-566
  • British National Formulary for Children, Corticosteroids. Vol. 54: BMJ Publishing Group, 2007:434-437
  • British National Formulary for Children, Drugs which suppress the rheumatic disease process. Vol. 54: BMJ Publishing Group, 2007:575
  • Arthritis (juvenile idiopathic) - etanercept. 2002. www.nice.org.uk
  • Juvenile idiopathic arthritis. UCL Institute of Child Health, GOSHfC. www.ich.ucl.ac.uk, accessed 23 January 2008

Related topics

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Rheumatoid arthritis