What is juvenile idiopathic arthritis (jia)?

Juvenile idiopathic arthritis is a disease that happens to children. It causes swollen and stiff joints. Experts think it happens when a child's natural defenses (immune system) attack his or her joints.

Your child may have some pain and walk with a limp. And your child may develop eye problems.

Sometimes this disease is called juvenile rheumatoid arthritis.

Your child can take pills or get a shot in a joint to reduce pain and swelling. Physical therapy can help keep your child's joints flexible.

The course of juvenile idiopathic arthritis (JIA) is unpredictable, especially during the first few years after a child is diagnosed. JIA can be mild, causing few problems. It can get worse or disappear without clear reason. Over time, the pattern of symptoms becomes more predictable. Most children have good and bad days.

Some children who have JIA will have long-term problems. These problems range from occasional stiffness and limits on physical activity to the need for surgery such as joint replacement. But for most adults who had JIA as children, any long-term problems tend to be mild and don't affect their overall quality of life.

A child's long-term outlook depends on the type of JIA and any complications he or she has. Treatment also affects the child's long-term outlook. Starting treatment early may help lower the chance of long-term problems.

Children can have one or many symptoms, and although the symptoms come and go, they are long lasting. They include joint pain, swelling, and stiffness. A child may also have trouble sleeping and problems walking. Systemic JIA can cause fever spikes and a rash.

There are several types of JIA. Oligoarticular affects a few joints and is usually mild. Polyarticular affects more joints and is usually more severe. Systemic can be the most serious. This type can also affect organs. Enthesitis-related most often affects the areas where tendons and ligaments attach to bones (the enthesis).

Treatment goals for JIA are to reduce your child's joint pain and to prevent disability.

Most children with JIA need to take medicine to reduce inflammation, control pain, and to help prevent more damage to the joints. Physical therapy is also part of treatment.

Treatment depends on the type and severity of JIA. Your doctor will set up a treatment team. It may include a pediatrician, an ophthalmologist, a rheumatologist, and a physical and/or occupational therapist.

Surgery may be used in a very small number of children with JIA who have severe joint deformity, loss of movement, or pain.

Some children with JIA have no appetite, so malnutrition becomes a medical concern. If your child has little appetite for food, see a registered dietitian for help.

Medicines

Medicine will likely be an important part of your child's treatment.

• Disease-modifying antirheumatic drugs (DMARDs) may be used to prevent the arthritis from getting worse and injuring bones and joints.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and pain, especially before DMARDs can take effect.
• A corticosteroid pill or a corticosteroid shot into a joint is sometimes used.
• Combinations of medicines may also be used.

Physical therapy and home treatment

Treatment may include:

• Physical therapy. Regular exercise and range-of-motion exercises will help maintain joint range and muscle strength. And it will prevent shortening of the muscle or other tissue (contractures).
• Occupational therapy. An occupational therapist (OT) can help your child learn ways to do self-care activities, play, and take part in school without making symptoms worse. OT will also teach you and your child about using splints and casts.
• Balancing rest and activity. Mix extra naps or quiet times with activity each day.
• Assistive devices. These can help your child hold onto, open, close, move, or do things more easily. They include canes, braces, and devices to make getting around the house easier.
• A pain management plan. This can help you and your child control pain caused by JIA. The plan may include heat, cold, or water therapy. Some people try complementary medicine, such as massage, guided imagery, and acupuncture.

You and your child will be able to use many of the above treatment options at home. Home treatment can also include healthy eating, dealing with stiffness, and using assistive devices.

Follow-up

Treatment depends on the type of JIA and how severe it is. Even when JIA is uncomplicated, an affected child may need years of medical treatment or checkups. To make sure that your child's care is right for the stage of disease, work closely with the medical team. Learn as much as you can about your child's disease and treatments. And stay on schedule with medicine and exercise.

Inflammatory eye disease may develop in children with JIA. This form of eye disease generally has no symptoms. It can lead to a permanent decrease in vision or blindness. So part of your child's treatment plan should be regular checkups with an ophthalmologist.

JIA is often diagnosed after other possible causes have been ruled out and pain and stiffness have lasted for at least 6 weeks. Your doctor will ask questions about your child's symptoms and past health and do a physical exam. Your child may also have blood tests and a urine test.

You can help your child by doing things to relieve symptoms and prevent problems from developing. Encourage your child to do usual activities as much as possible. Help your child get the right mix of rest and exercise. See a physical therapist, and take steps to manage your child's pain.

The cause of JIA isn't well understood. Most experts believe it's caused by a combination of things, such as an immune system that's too active and attacks joint tissues. Viruses or other infections and certain genes that make the immune system more likely to attack joint tissues can also cause JIA.

Other health problems (complications) linked with JIA can include:

• Inflammatory eye disease, such as uveitis. Children and adults with this condition can develop cataracts, glaucoma, corneal degeneration (band keratopathy), or vision loss.
• Growth abnormalities. These include unequal leg lengths, an imbalance in growth of the jaw, and temporary delay in breast growth.
• Joint damage, including changes in the cartilage and other tissues that line the inside of the joints, and changes to the bones themselves.

Some children with polyarthritis get arthritis in the neck that can cause the neck bones to fuse together.

Complications of systemic JIA include heart or lung problems, such as pericarditis, pleuritis, or pericardial effusion. A rare lung complication is the formation of scar tissue in the lungs (pulmonary fibrosis).

Juvenile idiopathic arthritis (JIA) is a disease that happens to children. It causes inflamed, swollen joints. This makes joints stiff and painful. Your child may have some pain and may walk with a limp. Some children with JIA grow out of it after they get treatment. Others will need ongoing treatment as adults.