Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis, juvenile idiopathic arthritis (JIA), is a type of arthritis that affects children under the age of 16. It is a chronic condition characterized by inflammation of the joints, causing pain, swelling, and stiffness. The exact cause of JIA is unknown, but it is believed to be an autoimmune disorder in which the body’s immune system attacks its own tissues, causing inflammation in the joints.
There are seven subtypes of JIA, each with its own set of symptoms and treatment options. These subtypes are:
- Oligoarthritis: This type of JIA affects four or fewer joints in the first six months of the disease. It is the most common subtype of JIA and affects approximately 40% of children with JIA.
- Polyarthritis: This type of JIA affects five or more joints in the first six months of the disease. It is the second most common subtype of JIA and affects approximately 30% of children with JIA.
- Systemic arthritis: This type of JIA is characterized by the presence of systemic symptoms such as fever, rash, and enlarged lymph nodes. It affects approximately 10% of children with JIA.
- Psoriatic arthritis: This type of JIA is associated with psoriasis, a skin condition characterized by red, scaly patches. It affects approximately 5% of children with JIA.
- Enthesitis-related arthritis: This type of JIA is associated with inflammation of the tendons and ligaments where they attach to bones. It affects approximately 5% of children with JIA.
- Undifferentiated arthritis: This type of JIA does not fit into any of the above categories and is diagnosed when a child has joint inflammation but does not meet the criteria for any of the other subtypes.
- Juvenile scleroderma: This type of JIA is associated with thickening and hardening of the skin and underlying tissues. It is a rare subtype of JIA and affects only a small number of children with JIA.
Causes
The exact cause of JIA is unknown, but it is believed to be a combination of genetic and environmental factors. In this article, we will discuss the potential causes of JIA:
- Genetics: JIA is believed to be a genetic disorder, and a family history of the condition increases the risk of a child developing JIA.
- Autoimmunity: JIA is an autoimmune disorder, meaning that the body’s immune system mistakenly attacks healthy tissues in the joints, causing inflammation and damage.
- Infections: Certain infections, such as rubella, mumps, and cytomegalovirus, have been linked to the development of JIA.
- Environmental triggers: Exposure to environmental triggers, such as cigarette smoke or air pollution, can increase the risk of JIA.
- Vitamin D deficiency: Low levels of vitamin D have been associated with an increased risk of JIA.
- Hormonal imbalances: Hormonal imbalances, such as those occurring during puberty, can trigger the onset of JIA.
- Obesity: Children who are overweight or obese are at an increased risk of developing JIA.
- Stress: Chronic stress has been linked to the development of JIA, as it can weaken the immune system and trigger inflammation.
- Gut microbiome: The balance of bacteria in the gut, known as the gut microbiome, has been linked to the development of JIA.
- Diet: A diet high in processed foods and sugar has been linked to an increased risk of JIA.
- Food sensitivities: Certain food sensitivities, such as gluten sensitivity, have been linked to the development of JIA.
- Lack of physical activity: Children who are physically inactive are at an increased risk of developing JIA.
- Exposure to toxins: Exposure to environmental toxins, such as lead or pesticides, has been linked to the development of JIA.
- Lack of sleep: Children who do not get enough sleep are at an increased risk of developing JIA.
- Vitamin deficiencies: Deficiencies in certain vitamins, such as vitamin C or E, have been linked to the development of JIA.
- Chronic inflammation: Chronic inflammation, such as that caused by conditions like allergies or asthma, can increase the risk of JIA.
- Smoking: Children who are exposed to secondhand smoke are at an increased risk of developing JIA.
- Nutrient deficiencies: Deficiencies in certain nutrients, such as iron or calcium, have been linked to the development of JIA.
- Exposure to radiation: Exposure to ionizing radiation, such as that from X-rays or medical treatments, has been linked to the development of JIA.
- Lack of breastmilk: Children who are not breastfed are at an increased risk of developing JIA.
- Exposure to viruses: Exposure to certain viruses, such as the human parvovirus B19, has been linked to the development of JIA.
- Premature birth: Children who are born prematurely are at an increased risk of developing JIA.
- Low birth weight: Children with a low birth weight are at an increased risk of developing JIA.
Symptoms
Here are common symptoms of JRA:
- Joint pain: Children with JRA may experience pain in one or more joints, which can range from mild to severe.
- Joint swelling: Swelling in the affected joint or joints is a common symptom of JRA.
- Stiffness: Children with JRA may experience stiffness in the affected joints, especially after periods of inactivity or upon waking up in the morning.
- Redness: The affected joint may become red and warm to the touch, indicating inflammation.
- Decreased range of motion: Children with JRA may experience a decrease in the range of motion in the affected joint or joints.
- Fatigue: Children with JRA may feel tired and have less energy than usual.
- Fever: Children with JRA may experience fever, which can be a sign of inflammation.
- Weight loss: Children with JRA may experience weight loss, which can be a result of decreased appetite or increased energy expenditure.
- Anemia: Children with JRA may develop anemia, which is a condition characterized by a low red blood cell count.
- Rashes: Children with JRA may develop rashes on their skin, which can be a sign of inflammation.
- Eye inflammation: Children with JRA may experience eye inflammation, which can cause redness, pain, and vision problems.
- Growth problems: Children with JRA may experience growth problems, such as a delay in growth or a decrease in height.
- Nodules: Children with JRA may develop nodules, which are small lumps under the skin near the affected joint.
- Muscle weakness: Children with JRA may experience muscle weakness, especially in the affected joint or joints.
- Abnormal gait: Children with JRA may develop an abnormal gait, which is a way of walking that is affected by the pain and stiffness in the affected joint or joints.
- Deformities: Children with JRA may develop deformities in the affected joint or joints, such as a bent finger or a crooked wrist.
- Painful and swollen lymph nodes: Children with JRA may experience painful and swollen lymph nodes, which can be a sign of inflammation.
- Mouth sores: Children with JRA may develop mouth sores, which can be a sign of inflammation.
- Numbness or tingling: Children with JRA may experience numbness or tingling in their hands or feet, which can be a result of nerve damage.
- Depression or anxiety: Children with JRA may experience depression or anxiety as a result of the chronic pain and limitations imposed by the disease.
It is important to note that the symptoms of JRA can vary from child to child and can also change over time. Some children may experience symptoms that are severe and persistent, while others may have mild symptoms that come and go.
Diagnosis
The diagnosis and management of JRA requires a multi-disciplinary approach and a thorough evaluation of the child’s symptoms.
Diagnosis of Juvenile Rheumatoid Arthritis:
- Physical examination: The doctor will examine the child’s joints for signs of swelling, redness, warmth, and tenderness. The doctor may also assess the child’s range of motion and observe their posture and gait.
- Medical history: The doctor will ask questions about the child’s symptoms, including when they started, how long they last, and how severe they are. The doctor may also ask about the child’s family history of arthritis and other autoimmune disorders.
- Blood tests: Blood tests can help to determine if the child has JRA. The doctor may order tests such as the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and antinuclear antibody (ANA) test.
- X-rays: X-rays can help to visualize the bones and joints and determine if there is any damage or deformity.
- Magnetic resonance imaging (MRI): An MRI uses a powerful magnetic field and radio waves to produce detailed images of the bones and joints. It can help to identify inflammation and damage to the joints that may not be visible on x-rays.
- Synovial fluid analysis: The doctor may take a sample of fluid from the affected joint and send it to a laboratory for analysis. This can help to determine if there is any inflammation or infection in the joint.
- Joint aspiration: The doctor may remove a small amount of fluid from the affected joint using a needle. This can help to relieve pressure and provide relief from pain and swelling.
Treatment
Treatment for JRA is aimed at reducing inflammation, preventing joint damage, and improving joint function. There is no cure for JRA, but with the right treatment, children can lead normal, active lives. The goal of treatment is to minimize the impact of the disease on the child’s daily life and overall well-being. Here are some of the treatments for JRA:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the most commonly used medications for reducing pain and inflammation in JRA. They work by blocking the production of prostaglandins, which are substances that cause pain and inflammation. Some examples of NSAIDs are ibuprofen, naproxen, and indomethacin.
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
DMARDs are medications that slow down the progression of JRA and prevent joint damage. They work by suppressing the immune system and reducing inflammation. Some common DMARDs used for JRA are methotrexate, sulfasalazine, and leflunomide.
- Biologic Response Modifiers (BRMs)
BRMs are newer medications that target specific components of the immune system to reduce inflammation. They are usually used when other treatments are not effective. Examples of BRMs used for JRA include tumor necrosis factor (TNF) inhibitors like etanercept, infliximab, and adalimumab, and interleukin-1 (IL-1) inhibitors like anakinra.
- Corticosteroids
Corticosteroids are powerful anti-inflammatory medications that can be taken orally or given as a shot. They are usually used in short-term or intermittent doses to quickly reduce inflammation and pain. Examples of corticosteroids used for JRA include prednisone and methylprednisolone.
- Physical Therapy
Physical therapy can help children with JRA improve joint function, maintain range of motion, and reduce pain. A physical therapist can develop an individualized exercise program for the child, which may include stretching, strengthening, and low-impact activities like swimming.
- Occupational Therapy
Occupational therapy can help children with JRA learn new ways to perform daily activities and maintain independence. An occupational therapist can also provide adaptive equipment and assistive devices to help with activities like dressing, writing, and playing.
- Assistive Devices
Assistive devices such as crutches, canes, braces, and splints can help children with JRA reduce pain and improve mobility. An occupational therapist or physical therapist can recommend the appropriate device for the child based on their specific needs.
- Surgery
In severe cases of JRA, surgery may be necessary to repair or replace damaged joints. Surgery may be recommended to relieve pain, improve joint function, and prevent further joint damage.
- Assistive Devices
Assistive devices, such as braces and crutches, can help reduce stress on the joints and improve mobility. They can also help children with JRA maintain an active lifestyle.
- Complementary and Alternative Therapies
Complementary and alternative therapies, such as acupuncture, massage, and herbal remedies, can help manage the symptoms of JRA. However, it’s important to speak with a doctor before starting any complementary or alternative therapy, as some may interact with other medications.
- Non-pharmacological treatments: Non-pharmacological treatments for JRA include physical therapy, occupational therapy, and exercise. Physical therapy can help improve joint mobility and strength, while occupational therapy can help children perform daily activities more easily. Exercise is also important for maintaining joint health and flexibility.
- Joint injections: Joint injections of corticosteroids or other medications can be used to reduce inflammation and pain in specific joints.
- Splints and braces: Splints and braces can be used to support and protect affected joints, reducing pain and improving function.
- Heat and cold therapy: Heat and cold therapy can be used to reduce pain and improve joint mobility. For example, applying a warm towel to an affected joint can help reduce pain and stiffness, while applying an ice pack can help reduce swelling.
- Aquatic therapy: Aquatic therapy involves exercises performed in a pool, which can be a low-impact way to improve joint mobility and strength.
- Massage therapy: Massage therapy can help reduce muscle tension and improve joint mobility.
- Acupuncture: Acupuncture is a traditional Chinese therapy that involves the insertion of fine needles into specific points on the body. It is sometimes used to relieve joint pain and improve joint function.
- Chiropractic: Chiropractic is a form of manual therapy that involves adjusting the spine and other joints to improve function and reduce pain.
- Yoga: Yoga is a form of exercise that involves stretching and strengthening the muscles. It can be helpful for reducing joint pain and improving joint mobility.
- Tai chi: Tai chi is a form of exercise that involves slow, flowing movements. It can be helpful for reducing joint pain and improving joint mobility.
- Dietary changes: Certain dietary changes, such as avoiding nightshade vegetables, can help reduce joint pain and inflammation in some people with JRA.
- Supplements: Supplements, such as glucosamine and chondroitin, can help improve joint health and reduce pain.
Medications
Here is a list of 30 drugs used to treat JIA:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
- Disease-modifying antirheumatic drugs (DMARDs)
- Biologic response modifiers
- Tumor necrosis factor (TNF) inhibitors
- Interleukin (IL) inhibitors
- Janus kinase (JAK) inhibitors
- Abatacept
- Rituximab
- Anakinra
- Canakinumab
- Tocilizumab
- Siltuximab
- Baricitinib
- Upadacitinib
- Filgotinib
- Olokizumab
- Sarilumab
- Sirukumab
- TAK-659
- Pegylated interferon
- Conventional synthetic DMARDs
- Methotrexate
- Leflunomide
- Sulfasalazine
- Hydroxychloroquine
- Chloroquine
- Penicillamine
- Gold compounds
- Intra-articular corticosteroid injections