Overview:

Juvenile idiopathic arthritis is an autoimmune condition that affects children lesser than 16 years of age. Early intervention can help promote a good quality of life and can avoid complications. The blog explains the condition of JIA in detail.

Juvenile means relating to children or youngsters who have not reached adulthood. Idiopathic means of unknown cause or origin. Thus, juvenile idiopathic arthritis (JIA) is a kind of arthritis which affects young people and causes joint pain. While the commonly affected joints are hands, knees, elbows, ankles and wrists, other joints can also be affected.

Earlier, this condition was known as juvenile rheumatoid arthritis; the name has now been modified as it is not a version of the adult condition of rheumatoid arthritis. JIA usually affects those under the age of 16 years.

What Causes JIA?

JIA is an autoimmune condition. In an autoimmune condition, the body’s immune system attacks its own cells. While we do not know what causes an autoimmune reaction, it is suspected that genetics does play a role in it. However, food allergies, lack of vitamins, toxins, etc. have been ruled out as possible causes.

In JIA, the immune system releases chemicals that attack the soft tissue lining the joints (the synovium). The function of the synovium is to produce a fluid that allows for friction-free joint movement. When the synovium is attacked, it results in the production of more fluid which in turn causes joint swelling and pain.

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Symptoms of JIA

• Pain at the joints – this pain is typically worse in the mornings while waking up and while changing posture after a long time.
• Joints are visibly red and tender to touch.
• There is a feeling of fatigue for no obvious reason.
• Vision may be blurred.
• There may be rashes on the body.
• Appetite is reduced.
• The patient may also develop high fever.

The symptoms of JIA are not present at all times. There may be periods of inflammation followed by periods of remission. A period of inflammation is called a flare and it can even last for months.

Types of JIA

• Oligoarthritis: This is the most commonly observed type of JIA. It affects the larger joints and usually limits to affecting four or fewer than four joints.
• Polyarthritis: This constitutes around 25% of JIA cases. It affects joints on both sides of the body with both large and small joints getting affected. Unlike oligoarthritis, this type can affect 5 or more than 5 joints.
• Systemic: In this type, it is not just the joints that are affected but also the skin and organs. The patient will have high fever with rashes that could last for two weeks or more. Around 10% of children with JIA are afflicted with this sub-type.
• Psoriatic Arthritis: Here, the joint pain occurs along with a scaly skin condition which manifests behind the ears, on eyelids, on the scalp, etc. The skin symptoms can appear before or after the joint symptoms appear.
• Enthesitis-Related: Affecting children in the age group of 8-15 years, this subtype, alternatively known as spondyloarthritis, affects the areas where the muscles, ligaments and tendons join the bone. Boys are afflicted with this particular type more than girls.
• Undifferentiated: Here, joint pain is present but does not match any of the above-mentioned sub-types.

Complications of JIA

When JIA is not given prompt treatment, the condition can affect the cartilage surrounding the joints and the bones themselves. Other body parts too can get affected.

• Eyes: A condition called uveitis that is seen with oligoarthritis can affect the child. Eye dryness, pain, blurry vision and light sensitivity are characteristic of uveitis.
• Bones: Long-term inflammation can lead to slow bone growth. Bones may also be prone to fractures.
• Jaws: Difficulties in chewing food and brushing and flossing teeth affect 50% of children with JIA.
• Neck: When there is spine involvement, the child may complain of neck pain.
• Ankle/Feet: Children with polyarthritis and enthesitis-related arthritis may have feet pain and trouble walking.
• Lungs & Heart: In systemic JIA, the lungs and heart may be affected due to long-term inflammation.
• Weight Management: Due to difficulty in walking, the child may not be able to exercise and this could lead to weight gain. Alternatively, when the child experiences jaws problems, eating food may be difficult and this could lead to weight loss.

Early treatment and management can control these complications significantly.

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Diagnosis

• The doctor will begin by asking about the child’s medical and family history.
• A physical examination will be done wherein the doctor will assess joint movement, pain, inflammation, etc. The eyes and skin will also be checked.
• Blood tests will be carried out.
• X-ray, MRI, etc. may be done to check for joint damage.

Treatment

Treatment for JIA will involve a combination of medication, lifestyle changes and complementary therapies. The goal of treatment will be to control inflammation and pain, improve mobility, improve long-term outcome and promote a better quality of life for the child.

• Medication: NSAIDs (non-steroidal anti-inflammatory drugs) for pain, DMARDs (disease modifying anti-rheumatic drugs) when NSAIDs are not effective, steroids, etc. may be given depending on the severity of the condition.
• A physiotherapist will help with exercises to maintain joint flexibility and mobility.
• An occupational therapist will help the child by suggesting ways to adapt to the surroundings. This will help the child be more participative and social.
• Joint surgery for treating JIA will be considered as the last treatment option.

Lifestyle Changes

• Children with JIA should be encouraged to eat healthy diets rich in fresh fruits, vegetables, whole grains and fatty fish. Processed and sugary foods must be avoided as they can aggravate inflammation. It is important to include calcium in the diet to promote bone strength.
• Heat treatments can help with joint stiffness while cold treatments can help with pain. Teaching children meditation and relaxation techniques will help.
• Exercises as taught by the physiotherapist should be performed regularly. They will help with mobility, flexibility and strength.

Coping with JIA

• Family members’ support is very important for a child dealing with JIA. It is not easy for the child and he/she may get depressed.
• Allow the child to express his/her anger or frustration at the condition. If needed, you can avail professional help too.
• Treat the child normally. Encourage participation in physical activities while keeping in mind the physiotherapist’s advice.
• Let your child’s school know about the condition so that together you can make it easier for the child.

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