Description

Juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, is the most common type of arthritis in children under the age of 16 years of age.

Juvenile idiopathic arthritis can cause persistent joint pain, swelling, and stiffness. Some children may experience symptoms for only a couple of months, while others have symptoms for many years.

Some types of juvenile idiopathic arthritis can cause serious complications, such as growth problems, joint damage and inflammation of the eyes. The treatment focuses on controlling pain and inflammation, improve function, and prevent damage.

Symptoms

The most common signs and symptoms of juvenile idiopathic arthritis are:

  • Pain. While your child may not complain of pain in the joints, you may notice that he or she limps — especially first thing in the morning or after a nap.
  • The swelling. Joint swelling is common, but is often seen in first place in the large joints such as the knee.
  • Stiffness. You may notice that your child seems to be more clumsy than usual, especially in the morning or after a nap.
  • Fever, swollen lymph nodes and rash. In some cases, high fever, swollen lymph glands or a skin rash on the trunk can occur — that is usually worse at night.

Juvenile idiopathic arthritis can affect one joint or many. There are different subtypes of juvenile idiopathic arthritis, but the main ones are systemic, oligoarticular and polyarticular. That type of your child depends on the symptoms, number of joints affected, and if the fever and skin eruptions are prominent features.

Like other forms of arthritis, juvenile idiopathic arthritis is characterized by times when symptoms flare up and the moments in which the symptoms may be minimal.

When to see a doctor

Take your child to the doctor if he or she has pain in the joints, swelling or stiffness for more than a week — especially if he or she also has a fever.

Causes

Juvenile idiopathic arthritis occurs when the body's immune system attacks its own cells and tissues. It is not known why this happens, but both heredity and environment seem to play a role.

Risk factors

Some forms of juvenile idiopathic arthritis are more common in girls.

Complications

Several serious complications can be the result of juvenile idiopathic arthritis. But keep a careful watch on the condition of your child and the search for adequate medical care can reduce the risk of these complications:

  • Eye problems.Some forms can cause swelling of the eyes. If this condition is left untreated, it can lead to cataracts, glaucoma and even blindness. Inflammation of the eyes frequently occurs without symptoms, so it is important for children with this condition to be examined regularly by an ophthalmologist.
  • Problems of growth. Juvenile idiopathic arthritis can interfere with your child's growth and development of bones. Some of the medicines used for the treatment, mainly corticosteroids, can also inhibit the growth.

Eye problems. Some forms can cause swelling of the eyes. If this condition is left untreated, it can lead to cataracts, glaucoma and even blindness.

Inflammation of the eyes frequently occurs without symptoms, so it is important for children with this condition to be examined regularly by an ophthalmologist.

Diagnosis

The diagnosis of juvenile idiopathic arthritis can be difficult due to pain in the joints can be caused by many different types of problems. There is No single test can confirm a diagnosis, but the tests can help rule out other conditions that produce similar signs and symptoms.

Blood tests

Some of the most common blood tests for suspected cases include:

  • The erythrocyte sedimentation rate (ESR). The sedimentation rate is the rate at which red blood cells settle in the bottom of a tube of blood. A high value can indicate inflammation. The measurement of the erythrocyte sedimentation rate is mainly used to determine the degree of inflammation.
  • The C-reactive protein. This blood test measures levels of general inflammation in the body, but in a different scale of the erythrocyte sedimentation rate .
  • Antinuclear antibodies. Antinuclear antibodies are proteins commonly produced by the immune system of people with certain autoimmune diseases, such as arthritis. This is a placeholder for an increase in the likelihood of inflammation of the eyes.
  • The rheumatoid factor. This antibody is occasionally found in the blood of children with juvenile idiopathic arthritis, and it may mean that there is a greater risk of damage caused by the arthritis.
  • Cyclic citrullinated peptide (CCP). As the rheumatoid factor, the CCP is another antibody that can be found in the blood of children with juvenile idiopathic arthritis and can indicate a greater risk of damage.

In many children with juvenile idiopathic arthritis, no significant abnormality was found in these blood tests.

Imaging scans

X-rays or magnetic resonance imaging may be taken to exclude other conditions, such as fractures, tumors, infections or congenital malformations.

Image can also be used after the diagnosis to control the development of the bones and to detect the damage in the joints.

Treatment

Treatment for juvenile idiopathic arthritis focuses on helping your child maintain a normal level of physical and social activity. To achieve this, doctors may use a combination of strategies to relieve the pain and inflammation, maintaining the motion and strength, and to avoid complications.

Drugs

The medications that are used to help children with juvenile idiopathic arthritis are chosen to decrease pain, improve function and reduce possible damage to the joints.

Typical medications include:

  • Nonsteroidal anti-inflammatory drugs (Nsaids). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), to reduce pain and swelling. The side effects include stomach upset and, less frequently, the kidneys and the liver.
  • Disease-modifying antirheumatic drugs (DMARDs).Doctors use these drugs whenNSAIDsalone does not alleviate the symptoms of joint pain and swelling, or if there is a high risk of damage in the future. DMARDsmay be taken in combination withNSAIDsand are used to slow the progress of the juvenile idiopathic arthritis. The most commonly usedDMARDfor children is methotrexate (Trexall, Xatmep, other). Side effects of methotrexate can include nausea, low blood counts, liver problems and a slight increase in the risk of infection.
  • Biological agents.Also known as biologic response modifiers, this newer class of drugs includes the tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi), and infliximab (Remicade, Inflectra, other). These medications may help to reduce systemic inflammation and prevent joint damage. Can be used withDMARDsand other medications. Other biological agents working to suppress the immune system in slightly different ways, including abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret) and tocilizumab (Actemra). All biological products can increase the risk of infection.
  • Corticosteroids.Medications such as prednisone may be used for the control of symptoms until other medications take effect. They are also used to treat inflammation, when it is not in the joints, such as inflammation of the sac surrounding the heart. These drugs can interfere with the normal growth and increased susceptibility to infection, and are therefore generally must be used for the shortest possible time.

Disease-modifying antirheumatic drugs (DMARDs). Doctors use these drugs when Nsaids alone fail to relieve the symptoms of joint pain and swelling, or if there is a high risk of damage in the future.

Dmards can be taken in combination with Nsaids and are used to slow the progress of the juvenile idiopathic arthritis. The most commonly used DMARD for children is methotrexate (Trexall, Xatmep, other). Side effects of methotrexate can include nausea, low blood counts, liver problems and a slight increase in the risk of infection.

Biological agents. Also known as biologic response modifiers, this newer class of drugs includes the tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi), and infliximab (Remicade, Inflectra, other). These medications may help to reduce systemic inflammation and prevent joint damage. Can be used with Dmards and other medications.

Other biological agents working to suppress the immune system in slightly different ways, including abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret) and tocilizumab (Actemra). All biological products can increase the risk of infection.

Corticosteroids. Medications such as prednisone may be used for the control of symptoms until other medications take effect. They are also used to treat inflammation, when it is not in the joints, such as inflammation of the sac surrounding the heart.

These drugs can interfere with the normal growth and increased susceptibility to infection, and are therefore generally must be used for the shortest possible time.

Therapies

Your doctor may recommend your child to work with a physical therapist to help keep joints flexible and to maintain the range of motion and muscle tone.

A physical therapist or an occupational therapist can make further recommendations about the best exercises and equipment protection for your child.

A physical or occupational therapist may also recommend that your child to make use of sets of braces or splints to help protect joints, and maintain in a good functional position.

Surgery

In very severe cases, surgery may be needed to improve the function of the joint.

Lifestyle and home remedies

Caregivers can help children learn self-care techniques that help to limit the effects of juvenile idiopathic arthritis. The techniques include:

  • Exercising on a regular basis. The exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on the joints.
  • The application of cold or heat. The stiffness affects many children with juvenile idiopathic arthritis, especially in the morning. Some children respond well to cold packs, especially after the activity. However, most of the children prefer the heat, such as a hot pack or a hot bath or shower, especially in the morning.
  • Eat well.Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help to maintain an appropriate body weight. The proper amount of calcium in the diet is important, because children with juvenile idiopathic arthritis are at risk of developing weak bones due to the disease, the use of corticosteroids, and the decrease of physical activity and body weight.

Eat well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help to maintain an appropriate body weight.

The proper amount of calcium in the diet is important, because children with juvenile idiopathic arthritis are at risk of developing weak bones due to the disease, the use of corticosteroids, and the decrease of physical activity and body weight.

Coping and support

The members of the family can play a critical role in helping children cope with their condition. As a parent, you can try the following:

  • Treat your child like other children in his family as much as possible.
  • Allow your child to express anger about having juvenile idiopathic arthritis. Explain that the disease is not caused by anything that he or she did.
  • Encourage your child to participate in physical activities, taking into account the recommendations of your doctor and physical therapist.
  • Discuss your child's condition and the issues related to teachers and administrators of your school.

Preparing for your appointment

If your pediatrician or family doctor suspects that your child has juvenile idiopathic arthritis, he or she may refer you to a doctor that specializes in arthritis (rheumatologist) to confirm the diagnosis and explore treatment.

What you can do

Before the appointment, you might want to write a list that includes:

  • Detailed descriptions of the symptoms of his son
  • Information about the medical problems your child has had in the past
  • The information about the medical problems that tend to run in your family
  • All the medications and dietary supplements that your child takes
  • Your vaccination status of the child
  • Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Which joints are affected?
  • When did the symptoms begin? Do they seem to come and go?
  • Is there something that the symptoms better or worse?
  • Is the stiffness of the joint worse after a period of rest?
Symptoms and treatment of the Juvenile idiopathic arthritis