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July is Juvenile Arthritis (JA) Awareness Month, a time to raise awareness of JA and other childhood rheumatic diseases.
Joint pain is usually associated with ageing, leading many people to assume arthritis affects only older adults. However, thousands of children worldwide live with a form of arthritis known as juvenile idiopathic arthritis (JIA).
Because many parents and caregivers are unaware that children can develop arthritis, symptoms may be mistaken for growing pains or temporary aches, delaying diagnosis and treatment.
Juvenile Idiopathic Arthritis
Juvenile Idiopathic Arthritis (JIA) is the most common type of chronic arthritis in children. It develops before age 16 and lasts at least six weeks. It is considered an autoimmune disease, meaning the body’s immune system mistakenly attacks healthy tissues, particularly the joints, causing inflammation.
This immune response and related inflammation can affect nearby tissues, eventually damaging the cartilage and bone. The inflammation can also affect other areas of your child’s body, especially their eyes. When left untreated, JIA can interfere with your child’s normal growth and development. However, treatment can significantly improve their overall quality of life.
The term “idiopathic” means the exact cause is unknown. Researchers believe a combination of genetic and environmental factors may contribute to the condition, but no single cause has been identified.
JIA is not contagious and is not caused by poor nutrition, cold weather, or parenting practices.
Types of Juvenile Idiopathic Arthritis
There are several subtypes of JIA, depending on the symptoms and the number of joints involved.
1. Oligoarticular: This is the most common type of JIA, which affects one to four joints, usually the knees or ankles, during the first six months of the disease. It mainly occurs in younger children and is more common in girls. Children with this type have a higher risk of developing uveitis (eye inflammation), so regular eye examinations are important.
2. Polyarticular JIA: Polyarticular JIA affects five or more joints, often including the hands, wrists, knees, and feet. It may involve joints on both sides of the body. It can resemble adult rheumatoid arthritis, especially when the rheumatoid factor (RF) is positive. Early treatment is essential to prevent joint damage and maintain mobility.
3. Systemic JIA: Systemic JIA affects the whole body in addition to the joints. It is characterised by recurring high fever, a salmon-pink rash, and inflammation that may involve organs such as the heart, lungs, liver, or spleen. Although less common than other types, it can lead to serious complications if not treated promptly.
4. Psoriatic JIA: Psoriatic JIA combines arthritis with psoriasis or a family history of the skin condition. Children may develop swollen fingers or toes, nail changes, and joint inflammation. The skin rash can appear before or after the arthritis. For this type, treatment focuses on controlling both joint and skin symptoms.
5. Enthesitis-Related JIA: This type causes inflammation where tendons and ligaments attach to bones, most commonly affecting the heels, knees, hips, or feet. It is more common in boys and may later involve the lower back and spine. Some children with this form carry the HLA-B27 gene, which is linked to inflammatory joint diseases.
Symptoms of Juvenile Idiopathic Arthritis
The most common signs and symptoms of juvenile idiopathic arthritis are:
- Pain: Your child may not complain of joint pain, but you may notice a limp, especially first thing in the morning or after a nap.
- Swelling: This often happens in larger joints, such as the knees.
- Stiffness: Your child may seem more awkward or clumsy than usual, especially after sleeping or resting.
- Fever, swollen lymph nodes and rash: In some cases, your child may have a high fever, swollen lymph nodes, or a rash on the chest, back or stomach. These symptoms often get worse in the evening.
Some children may have symptoms in only one or two joints, while others may experience inflammation throughout the body.
Causes of Juvenile Idiopathic Arthritis
Research reveals JIA happens when the body’s immune system mistakenly attacks its own healthy cells and tissues; however, its cause is unknown.
Risk factors
Some forms of JIA are more common in girls than in boys. While the reason for this is not fully understood, researchers believe it may be linked to differences in hormones and the immune system.
Genetics may also play a role. Some children inherit genetic variants, such as certain human leukocyte antigen (HLA) genes and other immune-related genes, that increase their risk of developing JIA. Having a family history of autoimmune diseases may also increase the risk, although these factors alone do not cause the condition.
Treatment for Juvenile Idiopathic Arthritis
Although there is currently no cure for JIA, treatment has improved significantly over the past few decades.
Management may include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate
- Biologic medicines that target specific parts of the immune system
- Corticosteroids in selected cases
- Physical and occupational therapy to maintain joint movement and muscle strength
- Regular eye examinations to detect silent eye inflammation early
Treatment plans are tailored to each child based on the severity and type of the disease.
Conclusion
Juvenile Idiopathic Arthritis is a chronic autoimmune disease that affects children, not just older adults. While there is no cure, early diagnosis and appropriate treatment can prevent long-term joint damage, reduce complications, and help children live healthy, active lives.