JUVENILE IDIOPATHIC ARTHRITIS (JIA)
Juvenile Idiopathic Arthritis (JIA)
- Yes, Arthritis can occur in children too…
- Arthritis in children is different from that of adult with arthritis
- Arthritis in children is not inherited from parents except in some types of JIA
- Arthritis in children is treatable)
- If diagnosed early and treated with appropriate medication then child can live normal live
- Some children can have remission in their disease
- Juvenile– Less than 16yrs of age
Idiopathic –Exact cause is unknown,
Arthritis-Inflammation of joint must last more than 6wks
- This type of arthritis can occur at any age starts from the first yr of age upto 16yrs of age
- JIA is completely different from rheumatic fever where ASO titer has been increased
- Apart from joint pain JIA can present as long duration of fever with skin rash, increase in lymph node, and eye inflammation
- There are several types of JIA
- a) JIA-Oligoarticular:
Usually involve less than 5 number of joints
Girls are more risk than boys
Occur mostly less than 7yrs of age
Increased risk of silent inflammation of eye (Chronic Uveitis) who has ANA positive
Some extended into polyarticular (>5joints) after 6months of onset of disease
- b) JIA- Polyarticular:
Usually involve five or more joints
Can occur at any age
Sometime same as adult with rheumatoid arthritis
Those have Rheumatoid factor positive has persistent disease and may extend into adult rheumatoid arthritis
- c) JIA-ERA (Enthesitis Related Arthritis):
Usually affects young boys of age more than 6yrs of age
Develop low back pain more in the early morning while after getting up from bed, heel pain
Lower limb joints such as knee, hip and ankle joints are commonly involved
Sometime can have sudden pain and redness in the eye (Acute anterior Uveitis)
This group is same as ankylosing spondylitis (AS) of adult age group
Mostly have HLA B 27 positive
Usually have family history of similar disease
- d) Systemic Onset JIA (SOJIA / Stills disease) :
Systemic onset JIA is otherwise known as Still’s disease
Child will have long duration of fever without any identifying cause for it.
Usually 3-6 yrs of age are involved. Boys and girls are equally involved
Along with long duration of fever the child develop skin rash and arthritis during spike of fever
During afebrile period child is normal and playful
Apart from fever, there is enlargement of lymph node, spleen and liver
It is a diagnosis of exclusion i.e. you should exclude infection and sometime malignancy
- Juvenile arthritis affects children of all ages and ethnic backgrounds.
- Depending upon the type of JIA the age group varies
- JIA- Oligoarticular – less than 7yrs of age,girls are more risk than boys
- JIA-Polyarticular-Can be seen at any age upto 16yrs of age
- JIA-ERA-usually boys with more than 6yrs of age
- SOJIA(Stills Disease)-at any age but mostly in the 3-6 yrs of age
- JIA is an autoimmune disorder.
- As a rule, the immune system helps fight off harmful bacteria and viruses. But in an autoimmune disorder, the immune system attacks some of the body’s healthy cells and tissues.
- No known cause has been pinpointed for most forms of JIA, there is no evidence to suggest that toxins, foods or allergies cause children to develop JIA.
- Some research points toward a genetic predisposition to JIA, which means the combination of genes a child receives from his or her parents may cause the onset of JIA when triggered by other factors.
- Most common symptom is joint pain and swelling more in the early morning for more than 6wks of period
- JIA-ERA child will have more of low back pain in the morning, heel pain, arthritis involving joints of the leg
- Sometime child will have long duration of intermittent fever with skin rash along with lymph node, liver and spleen enlargement
- Child can have frequent painful redness of the eye and difficulty in vision (recurrent anterior uveitis)
- Sometime due to late diagnosis child may develop deformity, limping while walking
- Parents should always watchful on the child if he or she is not playful with their friends / limping while walking/difficulty in writing because of joint pain
- JIA sometime difficult to diagnose because some children may not complain of pain at first and joint swelling may not be obvious.
- JIA should be diagnosed as early as possible to prevent the deformity of the joint
- There is no blood test that can be used to diagnose the condition.
- As a result, diagnosis of JIA depends on physical findings, medical history, and the exclusion of other diagnoses.
- Arthritis more than 6wks and age of onset less than 16yrs of age and excluding other etiology for the arthritis
- The most important step in properly treating juvenile arthritis is getting an accurate diagnosis.
- There is no single blood test that confirms any type of JA. Sometime investigation were done to exclude other causes.
- In children, the key to diagnosis is a careful physical exam, along with a thorough medical history.
- Any specific tests a doctor may perform will depend upon the type of JA suspected.
- There is no substitute to proper detail history and thorough clinical examination
- Blood tests and radiological tests were done to confirm the diagnosis and exclude other diseases.
- Blood test:
Complete blood count
Liver function test
ANA titer (Hep2)-for chronic Uveitis
HLA B27-For the JIA ERA
Sometime Bone marrow test to rule out malignancy
- Radiographic test:
Chest Xray P/A Xray Pelvis A/P Sometime MRI sacroiliac joint USG of the joint