Patient Education

JUVENILE IDIOPATHIC ARTHRITIS (JIA)

Juvenile Idiopathic Arthritis (JIA)

JIA Facts

  • 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
     ESR
     CRP (quantitative)
     Liver function test
     Rheumatoid factor
     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