JIA (Juvenile idiopathic arthritis)
Juvenile idiopathic arthritis (JIA) is the name given to a number of types of arthritis that occur in children.
JIA is an autoimmune condition. This means that the body’s immune system, which normally protects against infection, attacks healthy tissues by mistake, creating inflammation. The symptoms of JIA vary from person to person and can come and go from day to day and week to week. Symptoms will be worse during occasional ‘flares’; at other times the condition seems to disappear for a time.
Joints are sore and swollen because in JIA, the immune system attacks the synovium, the thin membrane that lines the joints and makes a fluid that helps them move smoothly. If inflammation is not treated, it can damage, joints, cartilage and bones and weaken muscles around the joint.
Juvenile means children aged 16 or younger
Idiopathic means the cause is unknown
Arthritis means conditions that cause joint pain and inflammation.
Who gets JIA?
JIA is more common in girls than boys and can occur at any age under 16. The exact causes are not known – current research indicates that genetic factors may play a part and infection or viruses may trigger the condition.
JIA usually affects the knees, hips, hands and feet, although other joints may be involved as well.
- joint pain, swelling, tenderness, stiffness, redness and warmth
- fatigue, fevers, loss of appetite or weight, and generally feeling unwell
- skin rashes
- swelling in lymph glands
- inflammation of the eyes (uveitis) and other organs of the body.
Types of JIA
The most common are:
- Oligoarthritis (from ‘oligo’ meaning few) occurs when up to four joints are affected, usually the knees and ankles. Children may also develop eye inflammation (iritis or uveitis).
- Polyarticular (from ‘poly’ meaning many). This type involves five or more joints, with the same joints on each side of the body affected, including fingers, toes, wrists, ankles, hips, knees, neck and jaw.
Less common types include:
- Systemic onset JIA (also known as Still’s disease).This usually includes fevers and rashes, and may cause inflammation of the internal organs. Symptoms may be confused with other childhood diseases such as measles or glandular fever.
- Enthesitis-related arthritis (ERA) describes inflammation of the ligaments and tendons around the joints. It most commonly affects the spine, heel, hips, knees and ankles.
- Psoriatic arthritis. This type can affect any number of joints and is usually associated with psoriasis, a scaly skin rash that may also affect the nails.
How is JIA diagnosed?
There is no single test for JIA and reaching a diagnosis may take time, which can be very frustrating for families. Your child will be referred to a paediatrician who will liaise with a paediatric rheumatologist (who specialises in children with arthritis). Diagnosis will be based on medical history, physical examination, blood tests, X-rays and other tests. Some of these are to rule out other diseases that cause pain and swelling in the joints, and they may need to be repeated.
How can I manage my child’s JIA?
Every child’s JIA is different and treatment may seem like ‘trial and error’ to find what works best. Your child is still growing, so their condition needs to be monitored closely and changes to treatment will be made from time to time.
The overall aim is for your child and family to lead as normal a life as possible. Treatment will depend on what form of JIA your child has, which joints are affected, how active the condition is, and how your child responds to the medicines prescribed. The good news is that if JIA is diagnosed early and managed well, most children will outgrow it. About half of children with JIA may not need treatment as adults.
- pain relievers (analgesics) can help your child feel more comfortable, be more active and sleep better but they do not reduce inflammation.
- non-steroidal anti-inflammatory drugs (NSAIDS) reduce inflammation and control stiffness and swelling, but they do not cure JIA. The most common side effects are stomach upsets.
- disease-modifying anti-rheumatic drugs (DMARDS) such as methotrexate can slow the progression of JIA by ‘calming’ the overactive immune system. They take several months to reach maximum effectiveness. Some children are more likely to catch infections and they should not be give live virus vaccinations (e.g. measles mumps, rubella, oral polio, chicken pox) while on DMARDS.
- corticosteroids are hormones that are produced naturally by the adrenal glands. As medicine, they can rapidly reduce pain and inflammation. They are most commonly given by injection into the inflamed joints
- biological therapies (biologics) are used to control pain, swelling and stiffness when DMARDS are not effective to control. Etanercept, adalimumab and tocilizumab are funded for JIA in New Zealand. They suppress the immune system so your child may be more likely to catch infections and should not be given live vaccinations while taking biologics.
Physical activity is essential for good health and wellbeing in children with JIA. Exercise helps reduce the pain of JIA, keeps muscles and bones strong, and improves confidence. You will need to find physical activities and sports that your child enjoys but that do not cause too much discomfort. Your child’s physiotherapist can advise on suitable activities and exercises. Swimming is great as it allows freedom of movement and it’s fun!
Managing pain and flares
Flares can happen after infections, periods of stress or changes in medication but they can also happen for no apparent reason at all. During a flare, you child may be in greater pain, joints may be more swollen and stiff, and they may be tired yet have trouble sleeping. In turn, this may affect their mood – leading to an ongoing cycle of pain and distress.
Together with your child, you can learn some strategies that will help them through a flare, such as deep breathing and relaxation techniques. You can also try hot and cold packs, massage, gentle stretching exercises and distraction.
JIA can cause tiredness so it’s important your child gets a good night’s sleep and maybe some rest during the day. Rest does not mean lying in bed all day as this can lead to further stiffness and loss of mobility. Try activities like listening to music, reading, and artwork instead.
Children with JIA can have trouble with their appetite, so it’s important to make sure they are eating enough to maintain a healthy weight and energy levels. A balanced diet is important, including plenty of fresh fruit and vegetables, and calcium-rich dairy products like milk, cheese and yoghurt.
Emotional and social support
JIA can be a challenge for you and your child as well as siblings and other family members. It may be difficult to explain what is happening during a flare. A team approach to managing your child’s arthritis will help, along with support from family, friends and teachers. Many families find it valuable to connect with others who are living with JIA, through the Arthritis New Zealand annual Children’s Camp and through Kids with Arthritis New Zealand (KWANZ). Find out more here (link to Children with arthritis page) or at www.kidswitharthritis.org.nz
Arthritis costs the economy $12.2 billion a year
48% of those with arthritis are of working age
Women are more affected by arthritis than men
People of any age can develop arthritis, including young children