Arthritis: Juvenile idiopathic (JIA)

Information

Juvenile idiopathic arthritis (JIA) is a group of autoimmune conditions that affect approximately 1-2 children in every 1000.

JIA is characterised by persistent joint inflammation.

Considered a chronic disease, JIA persists over time and may reoccur, although can go into remission in adulthood. The condition generally responds well to treatment and careful management. JIA affects both girls and boys and onset occurs before 16 years of age.

There are several types of JIA categorised by how many joints are affected and whether there is fever, rash or inflammation of internal organs.

Arthritis Australia publishes several information sheets about JIA.

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Signs and symptoms

The most common signs and symptoms of JIA are joint inflammation with swelling, redness and limited movement with or without pain of the affected joint/s. Inflammation can affect both small and large joints.

Onset can be gradual, with signs include stiffness or swollen joints especially on waking; limping or favouring one limb over another; and increased clumsiness, irritability and fatigue. Parents often report their child is generally ‘unwell’ and they may display slow growth or decreased appetite.

JIA can sometimes cause inflammation of the eyes called uveitis. It may include redness, light sensitivity and pain.

Systemic JIA features daily spiking fevers that can be accompanied by a rash and swollen lymph glands.

JIA is diagnosed in part by excluding other medical conditions and identifying persistent arthritis and inflammation through blood tests, medical imaging and physical examination. Some arthritic symptoms can be transient and result from injury, infection or allergic response and delay clear diagnosis.

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Treatment options

The overall aim of treatment is to reduce inflammation. This may require intervention from a range of specialists including a paediatric rheumatologist, physiotherapist, orthopaedic surgeon, and general practitioner.

The best outcomes are achieved by long-term management under the care of a paediatric rheumatology multidisciplinary team who will provide a personalised treatment plan.

Medication

Several medication treatments exist that aim to relieve symptoms , prevent long-term damage to the bones and joints and improve mobility.

The most commonly prescribed medications are:

Disease-modifying anti-rheumatic drugs (DMARDS)

Biological agents

Anti-inflammatory medications

Non-steroidal anti-inflammatory drugs (NSAID) such as naproxen, ibuprofen and indomethacin

Corticosteroids

Prednisone

Physiotherapy and rehabilitation

Improving and maintaining joint mobility is a key factor in managing JIA. This might involve specific exercises to do regularly at home or using splints or supports made specifically for each patient to assist movement and reduce pain.

Physical activity is beneficial to general wellbeing and has marked effects on mental health. Sport and exercise like swimming or bike riding that don’t place excessive stress on joints are best.

The rheumatology team’s aim is for your child to get back to what they like to do best. Don’t forget to talk to your specialist if you are involved in competitive sport at school.

Orthopaedic surgery

With improvements in treatment, fewer children require orthopaedic surgery, but in some cases where severe contracture or tightness of soft tissues has occurred, surgery may be recommended to increase the range of movement.

Where joints have suffered permanent damage or destruction from advancing disease, hip or knee replacement may be an option. If this is necessary, this usually occurs in late adolescence or early adulthood once the main growth spurts have occurred.

If you are using the internet to search for information about you child’s disease, in addition to the excellent Australian resources listed, we recommend information provided by Paediatric Rheumatology InterNational Trials Organisation (PRINTO)

PRINTO is an international public network of academic and/or clinical centres engaged in the research and clinical care of children with paediatric rheumatic diseases. They collect a lot of information world-wide and so the information they provide is reliable and up-to-date.

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