Juvenile Idiopathic Arthritis

What is it?

Juvenile Idiopathic Arthritis (JIA) is a very common type of arthritis that affects children up until their teens. As with adult arthritic conditions, it causes swelling and pain in the joints and has a range of effects on other parts of the body. We used to call it Juvenile Rheumatoid Arthritis (JRA) but recent research has shown it’s not the same disease as you would get in adulthood. Although we have identified six different types of JIA, the bad news is “idiopathic” means we’re not yet sure where it comes from. But researchers are working hard across the world to find out!

All arthritis diagnoses refer to an autoimmune disorder, which means the body attacks itself. A healthy immune system is needed to fight off viruses and bacteria, but when you have an autoimmune disease, you immune system has become confused and has started to attack it’s own cells. In the case of arthritis, inflammatory chemicals attack the lining of your joints, the synovium. Therefore, your joints may feel painful and tender or look red and irritated.

What are the Symptoms?

There are several very common symptoms that most people with any form of Juvenile Arthritis might experience. These include:

• Joint pain or stiffness
• Inflamed, tender or warm joints.
• Fatigue and a feeling of being run down.
• Blurry vision or dry, gritty eyes.
• Rash.
• Loss of Appetite.
• Fever.
• Flares: Periods when symptoms may come and go, worse one day than another.

For the six specific types of JIA, there are more symptoms that help us to understand which type you have and how to treat it. It’s very common for one form of JIA to develop into another later down the line, so it’s a good idea to have a bit of knowledge on all of the types to be additionally prepared.

• Oligoarthritis mainly affects the larger joints such as knees, elbows and ankles.
• Polyarthritis affects both large and small joints on both sides of the body and tends to affect more areas overall.
• Systemic JIA affects the whole body, including the skin and organs and presents with a very high fever of 103°F or above and a rash that persists for at least a fortnight.
• Psoriatic Arthritis (PsA) affects one or more joints and the skin, with a scaly rash in several prominent places; behind the ears, on the eyelids, scalp, belly button and knees. Skin symptoms tend to appear before joint symptoms.
• Enthesitis-Related JIA or Spondylarthritis affects the entheses: the place where muscles, ligaments and tendons attach to your bones. This is more common in boys between 8-15 years of age and can have a profound effect on the digestive tract, presenting as Crohn’s Disease or Ulcerative Colitis.
• Undifferentiated JIA symptoms don’t correlate enough with any of the subtypes, but inflammation is present in one or more joints.

Causes

Researchers still aren’t entirely sure what causes Juvenile Idiopathic Arthritis to strike. There are genetic factors to consider as with all arthritic diagnoses. Certain genes that some people carry can be activated by viruses, bacteria and other external factors, which in turn can lead to autoimmune disorders such as JIA developing.

That being said, there is no current evidence that your diet, exposure to toxins, allergies or a lack of certain vitamins and minerals contributes in any way.

Diagnosis

Finding out you or a loved one has Juvenile Idiopathic Arthritis can be a long process. The symptoms experienced may match a range of other diseases and these will need to be ruled out first.

Initially, pain and inflammation in one or more joints must have been occurring for six weeks or more. Anyone aged under 16 and experiencing these symptoms will likely be referred, with their caregivers, to a Rheumatologist – a doctor who specialises in muscular and joints disorders.

Secondly, they will take a full medical history of the patient and their family, followed by a physical examination and blood tests. Your doctor will look at the joints for pain, swelling, redness and limit of movement, but he may also check eyes and skin for symptoms. A complete blood profile will also be taken which may check for the following:

• Rheumatoid Factor (RF) – a standard test for adult arthritis, this may be used to diagnosis polyarthritis.
• Antinuclear Antibodies (ANA) – another standard test for arthritis, this may indicate JIA but can also show as positive in children without JIA.
• HLA-B27 Typing – a genetic marker test that looks specifically for conditions such as ankylosing spondylitis.
• Erythrocyte Sedimentation Rate / C-Reactive Protein (ESR / CRP) – a test to see if there is inflammation in the body. A high result means there is severe inflammation.

Follow-up tests may involve imaging of some type. These may include Ultrasound, X-ray, MRI or CT scans to look more closely at the affected joints for more information on what damage is being done.

Treatment

As with all arthritic diagnoses, all treatments are geared towards the reduction of symptoms and the increase in quality of life. There remains, as of now, no cure for any arthritis. But do not be discouraged; with early diagnosis and the correct treatment plan, people with JIA are mostly able to lead active and happy lives. Combined with the knowledge that research continues to be carried out, every day, to improve the treatments we can already provide, the outlook is increasingly positive for anyone with autoimmune disorders.

Treatments consist of medication, surgery, physical & psychological therapies. What works for one person may not work for another. But if you can find an individualised plan that provides relief and improvement to your condition, your medical team will help to support you with that.

Medication

Arthritic diseases benefit from having access to two very specific types of medication; those that reduce the symptoms, and those that control the diseases activity. Medications can be added and removed to your individual plan over time to suit your path specifically.

Symptom reduction medications include Non-steroidal anti-inflammatory drugs (NSAIDs) and Analgesics. These reduce inflammation, like Ibuprofen, or are painkillers like paracetamol. Both of those are available at your local pharmacy and drugstore (OTC) or can be given via prescription. Stronger NSAIDs and painkillers may also be available through prescription, speak to your doctor for more information.

Disease control medications include Disease modifying antirheumatic drugs (DMARDs) or Biologics. Both of these are relatively new types of medication and work by suppressing parts of the immune system to slow down the disease progression. The most common DMARD is Methotrexate and is usually what someone with arthritis will be given initially. Biologics are the most recent medication in the fight against arthritis. These work on more specific parts of the inflammatory process and tend to work faster. Both can be given by your doctor.

Physical Therapy

Alongside your Rheumatology doctor, you may be invited to consult with an Occupational Therapist. Their job is to enable their patients to lead active and fulfilling lives in whatever way possible and they have many techniques to help you out.

Young people and children with JIA are likely to struggle with their motor skills and balance, so weekly strength and flexibility exercise sessions could be available. Chiropractic techniques, such as body manipulation, massage and acupuncture may help to coordinate the larger muscle groups to work together better, or assistive devices such as braces may be suitable for you.

Taking a holistic view of physical health means looking after your body in every way that you can. Eating a healthier diet than previously might be beneficial, as well as taking specific supplements for energy and joint health; Omega 3 and other fish oils.

Exercise is also extremely important, and your doctor will be able to recommend the right type of activity for you; from walking, swimming and biking to yoga and other alternative exercises. Most importantly is finding the balance between activity and rest. Your body will need special care, at varying levels depending on the disease activity. So learning to listen to your body and taking regular rest periods is going to have a beneficial effect on your overall condition.

Psychological Therapy

As with all chronic diseases, the toll on our mental health can be devastating. Especially for children and young people, mental health issues can be difficult to identify. The consequence of living with a chronic pain condition means our risk of depression can increase dramatically. Professionally trained therapists and psychologists are available to help young people develop positive coping mechanisms, to have a space to talk about how they feel and find ways to regulate their moods through a difficult time.

Alongside this, occupational therapists will be able to provide meditation sessions, music and art therapy and reading sessions to provide respite. There are also several mentor and peer groups that bring together young people with arthritis as a support group that might be beneficial.

Surgery

A last resort for most arthritic diseases, and especially for those like JIA that affect children and young people, surgery is sometimes recommended. This is usually after all other options have been exhausted, and the benefit of surgery outweighs the risks. Your doctor and Orthopaedic Surgeon will be able to discuss more detail with you about your particular situation, but the most common surgeries for JIA are joint replacement, such as knee or hip and arthroscopy; the removal of loose cartilage.

Managing Symptoms and Living with the disease

Juvenile Idiopathic Arthritis, in its many forms, is now very manageable with the range of treatments we discussed above. A healthy mix of self-care and complying with your doctors recommendations will give you the best chance of fighting back and improving your overall quality of life.

If a loved one is living with JIA, you are probably looking at a child or a young person struggling with a chronic, painfully condition. It’s vitally important to understand the necessity of support networks. Whether this is family, friends or peer groups and specialist services, reassuring the person you care for that there are people on their side to support them is crucial. Being educated on the condition and being open and honest with your communication will have a profound effect on any person with JIA. Don’t be afraid to seek out help when you need it, and never give up.

Summary

JIA is an arthritic disease that affects children and young people. Anyone under the age of 16 can be diagnosed, and there are 6 different forms that we are aware of to date. Diagnosis involves medical history, physical examinations, blood tests and imaging techniques. There are so many treatments available and these can be tailored to you to improve your quality of life. Supporting people with JIA is essential, research is ongoing and always be hopeful for the future.