It may surprise you to know that there are about 300,000 children in the United States living with juvenile arthritis, a painful and potentially debilitating disorder. Since July is Juvenile Arthritis (JA) Awareness Month, it’s a perfect time to become aware of the challenges these youngsters face and to learn some facts about JA.

Children can have arthritis, too

Most people think that arthritis is unique to adults. While joint problems related to aging and wear and tear are uncommon in children, joint inflammation stemming from the immune system is found in both adults and children. Juvenile idiopathic arthritis (JIA) is not the rheumatoid arthritis adults experience; there are many significant differences between them.

When physicians speak about JIA, they refer to several conditions that are similar in some ways and different in others. The common characteristic is inflammation in one or more joints for at least six weeks. Because there are different types of JIA, it can differ in the number of joints involved and the presence of rashes, fevers, and so on. Each subtype has its own natural course and potential complications, and responds differently to common treatments.

Symptoms of Juvenile Idiopathic Arthritis

Pain, stiffness, swelling, or redness of joints signal arthritis. An illness, such as a cold, may precede the onset. Usually these symptoms progress over weeks, sometimes months. Some children may experience low-grade fevers, loss of appetite or fatigue. Children with systemic onset JIA often have high fevers, rash, enlarged lymph nodes, and feel ill.

Parents should consult their pediatricians if their children experience these symptoms. Not all joint pain is due to JIA, and joint inflammation that lasts days, not weeks, is very common in children with or following viral infections.

Diagnosing childhood arthritis

A pediatrician or pediatric rheumatologist will obtain a detailed medical history and perform a physical exam. Lab tests or imaging studies may be used to rule out other conditions, but there is no specific test or study to diagnose JIA. Essentially it is diagnosed clinically, and is defined as the presence of arthritis not due to a known illness that causes joint swelling in a child for at least six weeks.

Treating JIA

Treatment of JIA focuses on:

  • relieving pain
  • reducing or eliminating inflammation in the joints and other parts of the body
  • preserving joint function and range of movement
  • preventing long-term complications such as damage to bones and joints or other organs
  • maximizing the potential to achieve full growth

Pediatric rheumatologists commonly prescribe medication and physical therapy. Other specialists may also be involved in the care of patients with JIA.

Medications like ibuprofen are the first line of treatment. Steroid injections into the affected joints are also commonly used.

If these approaches fail, the pediatric rheumatologist may prescribe a different type of medication, called disease-modifying antirheumatic drugs (DMARDs). This type of drug often requires close monitoring of the patient. In the last 15 years, a new class of DMARDs called biologics have been used successfully to treat JIA.

Developments in treating JIA

The outlook for children with JIA depends largely on the subtype they have. In the last two decades, there have been promising developments. These stem from our improved understanding of the immune system and how it is involved in autoimmune and autoinflammatory diseases. Effective medicines have been developed based on this new understanding.

Today, JIA is a different condition than it was just 20 years ago. In the short term, most children with JIA who are treated have their disease under control, and are considered in remission. However, challenges remain. Though many children can stop taking medications and maintain remission, some relapse.

Special considerations for children with JIA

Youngsters who have active JIA should avoid high-impact sports and might be unable to participate in vigorous exercise. It is important, however, to find physical activities they can tolerate that will maintain muscle strength and endurance.

The future of JIA research 

Since the exact cause of JIA remains unknown, it is not yet possible to “cure” it. However, many research studies are underway to improve our understanding of JIA. These focus on:

  • diagnosing patients with greater precision
  • matching the right type of medicine to the patient
  • developing medications with fewer side effects that are easier and less expensive to administer
  • predicting which patients are likely to go into remission or to relapse
  • providing better outcomes for patients

If your child is experiencing signs of JIA, we can help. Visit Hasbro Children's Hospital's Pediatric Rheumatology for more information.

Ali Yalcindag, MD

Dr. Ali Yalcindag is a pediatric rheumatologist at Hasbro Children’s Hospital