Patient education: Juvenile idiopathic arthritis (The Basics)

What is juvenile idiopathic arthritis? — Juvenile idiopathic arthritis, or "JIA," is a condition that can cause stiff, swollen, or painful joints and other symptoms in children. It used to be called "juvenile rheumatoid arthritis." Arthritis means inflammation of the joints. It happens when the body's infection-fighting system, called the "immune system," attacks the joints.

There are several different types of JIA. They include:

●Systemic arthritis – This affects 1 or more joints and causes a fever. It can also cause:

•A rash

•Problems with the tissues covering the heart, lungs, and digestive tract

•Swelling of the liver, spleen, and lymph nodes

Systemic arthritis is equally common in boys as in girls.

●Polyarthritis – This affects 5 or more joints. It is more common in girls than in boys. It is also called "polyarticular arthritis."

●Oligoarthritis – This affects fewer than 5 joints. It is the most common type of juvenile arthritis. About half of children who have juvenile arthritis have this type. It is more common in girls, and usually starts at age 2 to 3 years. Children 10 years and older rarely get it. It is also called "oligoarticular arthritis" or "pauciarthritis."

●Enthesitis-related arthritis – This most often affects the leg and back joints. It can also cause pain where tendons connect to bones (called "enthesitis"). It usually starts later in childhood. It is more common in boys than in girls. It is a type of "spondyloarthropathy" or "spondyloarthritis."

●Psoriatic arthritis – This affects 1 or many joints. It can also cause a rash and nail changes. Children can have sausage-like swelling of fingers or toes (called "dactylitis"). It is more common in girls than in boys. It is rare in children under 1 year old. It is another type of "spondyloarthropathy" or "spondyloarthritis."

What are the symptoms of JIA? — Symptoms can include:

●Fever – Children with systemic arthritis sometimes get a fever at the same time every day for 2 weeks or more. The fever can go away but come back around the same time the next day.

●Rash – Children with systemic arthritis sometimes get a rash. It can appear anywhere on the body, but often affects the armpits and waist. In children with lighter skin, the rash can be easy to see when the child has a fever. In children with darker skin, it might be harder to see the rash. The rash might go away when the fever goes down and start again when the fever comes back.

Children with psoriatic arthritis can get a different type of rash. This rash looks like raised, red or purple patches of skin that are sometimes covered by silver or white scales. The rash can be hard to see if it is in the joint creases, in the hairline, or behind the ears (picture 1).

●Pain, stiffness, and swelling in the joints:

•The joint symptoms happen in all types of JIA.

•The joints affected depend on which type of arthritis the child has. Many types affect the wrists, elbows, knees, and ankles. But other joints can be affected, too, such as the hands and jaw. Enthesitis-related arthritis and psoriatic arthritis can affect the back and hips.

•Arthritis sometimes happens in the same joint on both sides of the body. For example, it might happen in both knees or both wrists.

•Children might not always communicate that a joint with arthritis is hurting. They often find a way to keep doing their regular activities despite pain. For example, a child might "walk funny" in the morning and get better in a few hours after their stiffness improves.

●Eye redness – Inflammation in the eye (called "uveitis") can cause eye redness. It is usually painless, but can be serious. Uveitis can lead to vision loss, so mention this symptom to your child's doctor.

Should my child see a doctor or nurse? — If your child has a stiff, swollen, or painful joint, see a doctor or nurse.

Will my child need tests? — Yes. The doctor or nurse will do an exam and ask about your child's symptoms. Many other conditions cause symptoms similar to JIA. These include infections, autoimmune diseases, cancer, and other diseases. The doctor or nurse can order blood tests to see if your child has a different condition.

Children with JIA also need to see an eye doctor (also called an "ophthalmologist") to check for uveitis. Often, uveitis does not cause symptoms until it has damaged the eye. That's why it's important to get regular eye exams.

How is JIA treated? — Doctors use several different medicines to treat arthritis in children. These can help joint pain and stiffness. They can also treat fever, rash, and other symptoms. Medicines can include:

●NSAIDs, such as ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve).

●Disease-modifying antirheumatic drugs, or "DMARDs" – There are different DMARDs. Some are known as "biologics." Depending on which medicines your child's doctor prescribes, they might be given as a pill or liquid by mouth, or as a shot that goes under the skin or through an "IV." (An IV is a thin tube that goes into a vein.)

Doctors might also recommend:

●Physical therapy, if the arthritis causes muscle problems

●Vaccines to help prevent certain infections

●Medicines to treat problems caused by the arthritis, such as uveitis or growth problems

●Surgery to fix problems caused by the arthritis, such as having 1 leg that is longer than the other

More on this topic

Patient education: Psoriatic arthritis in children (The Basics)
Patient education: Rheumatoid arthritis (The Basics)
Patient education: Uveitis (The Basics)
Patient education: Fever in children (The Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) (The Basics)

Patient education: Psoriatic arthritis (Beyond the Basics)
Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Fever in children (Beyond the Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)