Juvenile Idiopathic Arthritis

Juvenile rheumatoid arthritis (JRA) used to be the common way to refer to the most common type of arthritis in kids and teens.

However, it is now typically called juvenile idiopathic arthritis (JIA). Doctors made this distinction because JIA is not just the “kid version” of rheumatoid arthritis (RA).1

What is JIA?

JIA is an autoimmune disease, like RA. In an autoimmune disease, the immune system malfunctions and attacks the healthy tissue of the body.

In JIA, the tissue lining around the joint (synovium) is attacked. Inflamed synovium can cause joints to be swollen, red, and painful.1

JIA can begin at any age, but it is rare in babies less than 6 months old. Arthritis is considered juvenile if it begins before someone is 16 years old. Doctors do not know why certain people develop autoimmune diseases like JIA. It is possible that kids with JIA have a certain gene that makes them more likely to develop arthritis.2

Types of JIA

There are 7 different types of JIA. It is possible to start with 1 type of JIA but develop symptoms of another type later. Both symptoms and the chance of JIA lasting into adulthood can depend on which type a child has. The 7 types are:2-4

  • Oligoarticular JIA – Affects 4 or fewer joints at the beginning of the disease. The number of affected joints may increase later. This is the most common type of JIA.
  • Systemic onset JIA – Can affect the entire body. It typically begins with a high fever lasting more than 2 weeks and a rash. This makes up about 10 percent of all JIA cases.
  • Polyarticular arthritis, rheumatoid factor negative – Affects at least 5 joints, often on both sides of the body. It can affect large or small joints. This makes up about 25 percent of all JIA cases.
  • Polyarticular arthritis, rheumatoid factor positive – This type is most similar to rheumatoid arthritis, with more risk of joint damage.
  • Psoriatic arthritis – Causes joint pain and a scaly rash. The rash can be behind the ears and/or on the eyelids, elbows, knees, belly button, and scalp.
  • Enthesitis-related arthritis – Affects the areas where tendons or ligaments attach to the bone, like the hips, knees, and feet. It can also affect fingers, elbows, chest, and the lower back. It is sometimes called spondyloarthritis.
  • Undifferentiated arthritis – Arthritis that does not fully fit the criteria for the above categories, or it fits more than 1 of the above categories.

Symptoms

Certain symptoms of JIA depend on the type a child has. However, some symptoms are more common and universal. Some of these symptoms include:1

  • Joint pain or stiffness that may get worse after staying in one position for too long
  • Red, inflamed, swollen, or warm joints
  • High fever
  • Loss of appetite
  • Feeling very tired
  • Rash
  • Dry, gritty eyes or blurry vision

Diagnosis

JIA can be tricky to diagnose because children are not always positive for the antibodies that are a sign of arthritis. Usually, the diagnosis process is based on medical history, a physical exam, and tests.2

A medical history can help the doctor rule out causes like injury or infections. During a physical exam, the doctor will likely check joints for inflammation. The doctor may also check the eyes and skin. Blood tests may show results that indicate arthritis, but this is not certain. The doctor may also use the blood tests to rule out other diseases.1

A child is diagnosed with JIA if there have been symptoms for more than 6 weeks, they are under 16, and any other diagnosis has been excluded. Other conditions a doctor may want to rule out include infections, childhood cancer, bone disorders, Lyme disease, and lupus.2

Treatment

Unfortunately, we do not know of a cure for JIA. However, remission, which is a time with little disease activity or symptoms, is possible.

Early and aggressive treatment can be key in controlling JIA. Specific treatment may depend on the type and severity of the case. In general, treatment includes medicine, therapy, and self-care strategies.1

A doctor may recommend drugs to control the disease, called disease-modifying antirheumatic drugs (DMARDs). One type of DMARD is called a biologic. Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. This process turns the cells into drugs that can treat JIA. A doctor may recommend drugs to manage symptoms. This could include steroids or pain relievers.2

Physical or occupational therapy can also help children with JIA. These therapies can help improve motor skills and balance. They can also improve strength and flexibility, which may reduce joint pain.1

Self-care strategies are steps your child can take to treat a disease. Some strategies that may help with JIA include:1

  • Staying active – Regular exercise helps ease joint stiffness and pain. Activities should be low-impact and approved by a doctor.
  • Healthy diet – Some foods like high-fat, sugary, and processed foods are known to cause inflammation.
  • Alternative therapies – Massage, meditation, and acupuncture may help reduce pain and anxiety.

Children with JIA should be encouraged to attend school, join activities, and remain active. This can help reduce the risk of mental health problems, which are sometimes caused by chronic diseases. A JIA diagnosis can be daunting. However, with proper care, a child with JIA can still have a happy and healthy life.1,2

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Written by: Juliette Daily | Last reviewed: April 2021