Juvenile Arthritis

The most common type of JA is Juvenile idiopathic arthritis (JIA) which has 6 subtypes (oligoarthrits, polyarthritis, systemic, enthesitis related, juvenile psoriatic arthritis or undifferentiated). The least common ones include, Juvenile dermatomyositis which causes muscle weakness and skin rash on eyelids and knuckles, Kawasaki disease which causes inflammation of blood vessels thus leading to heart complications, Juvenile scleroderma which causes the skin to tighten and become hard, and Juvenile lupus, with the common form being systemic erythematosus (SLE), which affects the joints, skin, kidneys, blood and other areas of the body. There is also mixed connective tissue disease which is associated with high levels of antinuclear antibody called anti-RNP and can include features of arthritis, lupus, and scleroderma, and Fibromyalgia which is a chronic pain syndrome related to arthritis, causing stiffness and aching long with fatigue and disrupted sleep.

• SystemicJIA occurs in about 10% of children with JIA. It is characterized by inflammation of at least one joint and is often accompanied by skin rash and a high fever that lasts at least 2 weeks.
• Oligoarticular JIA is characterized as arthritis affecting four or fewer joints, typically knees, ankles, and elbows. Children with oligoarthritis are also more likely to get chronic eye inflammation.
• Polyarticular JIA occurs in about 25% of children with JIA. It is characterized by inflammation in five or more joints, often the small joints of the fingers and hands.
• Juvenile psoriatic arthritis is a form of arthritis that is combined with a skin disorder called psoriasis.
• Enthesitis-related JIA affects the hips, knees and feet. It is characterized by tenderness where the bone meets a tendon, or ligament.
• Undifferentiated arthritis is arthritis that does not fit in any of the other categories or it may involve symptoms of two or more subtypes making it difficult to diagnose as a specific subtype.

Most forms of juvenile arthritis are autoimmune disorders, which means that the body’s immune system—which normally helps to fight off bacteria or viruses—mistakenly attacks its own healthy cells and tissues. Resulting in inflammation, redness, pain, and swelling eventually leading to joint damage. Doctors do not know why the immune system attacks healthy tissues in children who develop juvenile arthritis. Scientists suspect it may be due to genetics as well as environmental related factors which triggers the development of the disease.

The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. Juvenile arthritis commonly affects the knees and the joints in the hands and feet. One of the earliest signs of juvenile arthritis may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic juvenile arthritis have a high fever and a skin rash. The rash and fever may appear and disappear very quickly. Systemic arthritis also may cause the lymph nodes located in the neck and other parts of the body to swell. In some cases (fewer than half), internal organs including the heart (very rarely), lungs, and gastrointestinal tract may be involved.

To be classified as juvenile arthritis, symptoms must have started before age 16. Unfortunately, no single test can be used to diagnose juvenile arthritis. A doctor diagnoses JA by carefully examining the patient, considering his or her medical history and the results of tests that help confirm or rule out other conditions. Doctors usually suspect JA, when they see children with persistent joint pain or swelling, unexplained skin rashes, and fever associated with swelling of lymph nodes or inflammation of internal organs A diagnosis of juvenile arthritis is also considered in children with an unexplained limp or excessive clumsiness. Specific findings or problems that relate to the joints are the main factors that go into making a juvenile arthritis diagnosis.

Ideally, the child’s care should be managed by a pediatric rheumatologist, who is a doctor who has been specially trained to treat the rheumatic diseases in children. The main goals of treatment are to preserve a high level of physical and social functioning and maintain a good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling, maintain full movement in the affected joints, relieve pain, and prevent, identify, and treat complications. Most children with juvenile arthritis need a combination of medication and non-medication treatments (physical activity and dieting) to reach these goals.