Understanding and managing Juvenile Idiopathic Arthritis(JIA) among Children

NOV 05, 2016

Inflammation of the joints is called arthritis. There are various types of arthritis and this can affect any part of the body. The most common type of arthritis in children is called Juvenile idiopathic arthritis (JIA) a rare disease that affects about 80-90 out of every 100,000 children. It is more common in girls.

What one needs to understand is that, Arthiritis, though a common condition found in older people, can occur even among babies and children. The type of arthritis among children is very different from the types that happen in adults. Arthritis can be due to various causes such as infections, malignancy and autoimmune disorders. Autoimmune conditions occur when our body’s immune system reacts against our own body causing inflammation, damage and destruction of our own tissues – in this case, the joints. Also, Arthritis can occur either in isolation (Juvenile idiopathic arthritis) or as part of a systemic disease such as SLE/Lupus, Scleroderma, Vasculitis etc.

Identifying the Problem

Children can develop one or more symptoms according to the type of arthritis. Some of the common symptoms are joint pains, joint swellings, limitation of movement, early morning stiffness, persistent unexplained fevers and rash. In babies and children, the symptoms may be more difficult to recognise. Parents may notice that the child is unable to get out of the bed or wants to be carried in the morning. Older children may limp or are noticeably slow in the morning. Symptoms often (but not always) improve during the course of the day but return after a period of prolonged rest. In some types of arthritis, the main feature is severe back pain or pain behind the heel. In fact, Children with the skin condition called psoriasis, may develop swelling of the entire finger or toe.

Diagnosing Juvenile idiopathic arthritis

JIA is a chronic disease characterized by persistent joint inflammation. Inflammatory arthritis starting before the age of 16 years and persisting for more than 6 weeks, when all other causes have been excluded is called JIA. JIA is not a hereditary disease but is the result of a combination of genetic factors and exposure to environmental factors (probably infections).In some children, JIA is associated with inflammation in the eyes(uveitis). However, there are several subsets of JIA.

The diagnosis of JIA is based on the presence and persistence of arthritis and the careful exclusion of any other disease by medical history, physical examination and laboratory tests. Investigations would include blood tests, X-rays and Ultrasound or MRI scans.

Treating JIA

With recent advances in medical treatments, most children with arthritis do well, can lead a normal life and go on to become independent adults.

The prognosis of arthritis depends on its severity, the clinical form of JIA, how early treatment begins and how adequate the course of treatment followed is. However, the prognosis for JIA has considerably improved by the progresses in therapy that have occurred over the last ten years.

The goal of treatment presently is to achieve early disease remission, prevent joint damage and maintain function by early aggressive treatment. The outcomes are even better if Children with the condition are diagnosed early and treated aggressively.

While treatment varies depending on the type of arthritis, the treatment approach and response also varies amongst the different subtypes. This should be done by a multi-disciplinary team consisting of Paediatric Rheumatologist, Paediatric Physiotherapist and Paediatric Ophthalmologist.

Treatment is based mainly on the use of special advanced drugs that inhibit inflammation and on rehabilitation procedures that preserve joint function and help to prevent deformities.

When only a few joints are involved, these can be treated with injection of steroids into the joint. When many joints are involved or in some specific types of JIA, other forms of treatment are necessary. Pharmacological treatment approaches to JIA has changed dramatically over the last 2 decades. The introduction of biologics in the late 1990s further revolutionised the treatment of this condition in children. With these recent advances in medicine, fears that “arthritis implies life in a wheelchair” are now things of the past.

However, if not properly treated, joint inflammation may produce damage by erosion of articular cartilage and bone and cause deformity which in turn can cause long-term problems such as pain, joint damage and disability with knock on effects on education and psychosocial wellbeing. Hence, treatment should continue as long as the disease persists. Though disease duration is unpredictable, the course of JIA often includes periods of remission and exacerbation, which require very different treatments. Therefore, treatment should be withdrawn completely only after prolonged and complete disease remission.

A positive attitude from parents who support and encourage the child to be as independent as possible despite the disease is extremely valuable in helping the child to overcome difficulties, to successfully cope with his peers and to develop an independent, well-balanced personality.