Unraveling the Mysteries of JIA
For a long time, I’ve wondered if there are differences between juvenile rheumatoid arthritis (now called juvenile idiopathic arthritis) and rheumatoid arthritis. Is the early onset during childhood the only distinction? Or is there more to the story? As an adult who has lived with JIA, I have puzzled over these questions for decades.
A new study published by the Journal of Rheumatology explores some of these questions. “Comparison of Adults with Polyarticlar Juvenile Idiopathic Arthritis to Adults with Rheumatoid Arthritis” compared 45 adults with polyarticular JIA and 94 with RA to explore clinical differences.
Juvenile idiopathic arthritis and RA
Differences in tests and diagnosis
Interestingly, the JIA patients were less likely to test positive for rheumatoid factor. (Much like me! I tested negative again recently despite having active disease.) Additionally, less than half of the JIA patients fulfilled the diagnosis criteria established for RA (2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria). This means diagnosing JIA patients can be very challenging because their symptoms do not always resemble classic RA.
On a personal note, I can attest to the diagnosis challenges from when I was a child. My swollen and painful left knee was my first symptom. It didn’t go away (obviously!) and it took a year of visiting various doctors before my parents found one who recognized I was very ill and did a battery of tests to diagnose my JIA.
Differences in treatment
Treatment data from the study was also very revealing with the JIA patients experiencing longer disease duration associated with the time from diagnosis to starting methotrexate. This also rings very true for me as methotrexate was not a treatment option for at least the first 10 years of my JIA. It only became available when I was a teenager and the risks were so scary (liver damage to a growing child!) that I didn’t take it until my late 20s.
The study also found that anti TNF treatments were more prevalent in JIA cases and that one biologic, in particular, was sustained longer as well (meaning, more drug switches for RA patients). RA patients were also more likely to be treated with DMARDS. This is interesting because it tells me that people with JIA are now having the option of using biologics and will stay on the drug if it works. In my opinion, having the biologics is huge for JIA patients because they have so far worked the best for preventing disease damage. This gives me hope that younger JIA patients are experiencing more effective treatment and less damage and disability from this aggressive chronic illness.
Patients with juvenile idiopathic arthritis and RA are different
One quote that I loved from the article: “Although often considered together in adult rheumatology practice, adults with pJIA are distinct from patients with RA.” This is so useful to see from researchers because as much as regular rheumatology has helped me over the years, it has been helpful when my doctors have acknowledged the long history I have with the disease (now 40 years!), as well as the fact that just maybe what is driving my disease activity is different. No RA fairy godmother came and tapped me on the shoulder at age 18 and changed my disease.
It means taking into account a long history of damage, but also complications over the years from treatment (like surgeries, infections, reactions, and more). As much as I have RA (or some form of it), I also have a special twist on the disease that I have to remember and respect.
Many more questions to explore
As the researchers note: “The ideal treatment for the adult pJIA patient is not known, and recommendations are generally extrapolated from the pediatric JIA and adult RA populations. In order to understand the impact of treatment on the outcome of adults with pJIA, the unique characteristics of this population must be more clearly defined.”
It was only last fall that I started a newer biologic treatment that pushed my CRP level (inflammation marker) down into the normal range and had me feeling better that I had in a long time. Is it any coincidence that the particular action in this drug stops an inflammatory marker that was found in research to potentially be a primary driver in disease activity for children with JIA? – Maybe not. While I have tried many treatments over the years, nothing ever came close to that result. My hope is that research like this can help other children and adults with JIA find a path that helps their disease and make their future a little easier.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?