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Arthritis - Juvenile Information

  • Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common form of persistent arthritis in children. JIA is sometimes referred to as juvenile chronic arthritis (JCA), a term that is not precise as JIA does not encompass all forms of chronic childhood arthritis...
  • Arthritis is the inflammation of the synovium (the lining tissues) of a joint.

    JIA is a subset of arthritis seen in childhood, which may be transient and self-limited or chronic. It differs significantly from arthritis commonly seen in adults (osteoarthritis, rheumatoid arthritis), and other types of arthritis that can present in childhood and are chronic conditions (e.g. psoriatic arthritis and ankylosing spondylitis).

    Symptoms of JIA are often non-specific initially, and include lethargy, reduced physical activity, and poor appetite. The first manifestation, particularly in young children, may be limping. The cardinal clinical feature is persistent swelling of the affected joint(s), which commonly include the knee, ankle, wrist and small joints of the hands and feet. Swelling may be difficult to detect clinically, especially for joints such as those of the spine, sacroiliac joints, shoulder, hip and jaw, where imaging techniques such as ultrasound or MRI are very useful.

    Pain is an important feature of JIA, but young children may have difficulty in communicating this symptom. Late effects of arthritis include joint contracture (stiff, bent joint) and joint damage. Children with JIA vary in the degree to which they are affected by particular symptoms.

    The cause of JIA, as the word idiopathic suggests, is unknown and currently an area of active research. Current understanding of JIA suggests that it arises in a genetically susceptible individual due to environmental factors.

    The 3 major types of JIA are oligoarticular JIA, polyarticular JIA and systemic JIA.

    The treatment of JIA is best undertaken by an experienced team of health professionals, including paediatric rheumatologists, nurse specialists, physiotherapists, occupational therapists, chiropractors and psychologists. Many others in the wider health and school communities also have valuable roles to play, such as ophthalmologists, dentists, orthopaedic surgeons, school nurses and teachers, careers advisors and, of course local general practitioners, paediatricians and rheumatologists. It is essential that every effort is made to involve the affected child and their family in disease education and balanced treatment decisions.

    There have been very beneficial advances in drug treatment over the last 20 years. Most children are treated with non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections. Methotrexate is a powerful drug which helps suppress joint inflammation in the majority of JIA patients with polyarthritis and systemic arthritis. Newer drugs have been developed recently, such as TNF alpha blockers, which appear to be effective in severe JIA. There is little or no controlled evidence to support the use of alternative remedies such as specific dietary exclusions, homeopathic treatment or acupuncture.

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