Arthritis is the inflammation of the joints, and while it’s a condition that we usually associate with the elderly, there are in fact several types of arthritis that can affect the younger generation. From babies to teenagers, it’s possible that they can have juvenile arthritis.
Knowing how to spot it means that measures can be taken to allow your child to live a full and normal life. Here, rheumatologist Dr Joel David explains the types, symptoms, diagnosis and treatment of juvenile arthritis.
What is juvenile arthritis and how common is it?
Juvenile idiopathic arthritis (JIA) is a term used to describe various conditions of inflammation (pain and swelling) of one or more joints that occur in children and teens under 16 years old. The term idiopathic means that the exact cause is unknown. In order for a JIA to be diagnosed, the inflammation needs to be present for at least six weeks and infection needs to have been excluded as a potential cause of the inflammation
JIA is most common in pre-school age children and is slightly more common in girls. It can also be present from as early as 9 months of age up to 16 years.
There are a number of different types of JIA - the number of joints affected and the distribution of joints determines the type. Knowing the type of JIA is helpful in planning treatment and predicting the future outcome.
What are the types of juvenile arthritis?
There are five main types of juvenile arthritis. These include:
- Enthesitis-related (around the knee, hip joint, and soles of feet primarily)
- Psoriasis-related arthritis
- Systemic arthritis
What are the symptoms of JIA?
If your child has any of these symptoms for more than a couple of weeks, you should see a doctor:
- Painful, swollen or stiff joint(s)
- Joint(s) that are warm to touch
- A fever that keeps returning
- A limp but no injury
How is juvenile arthritis diagnosed?
There isn’t a specific test for JIA, but the doctor will take blood tests and x-rays. They may also do other tests, including:
- An ultrasound or MRI scan to try to see if arthritis is present and to rule out other conditions
- Removing fluid from a joint (aspiration) to rule out joint infection
What treatment is available for juvenile arthritis?
Joint injections with steroids, while the child is under local anaesthetic, can be extremely helpful. If the child is very young, this may need to be performed under general anaesthetic. However, usually if the child is over seven years of age, they tolerate the procedure very well.
If many joints are affected, disease-modifying antirheumatic drugs (DMARD) will be required, such as methotrexate. This is given either as a tablet or via a weekly injection.
Occasionally, steroid treatment is needed. If the arthritis persists despite the treatment being maximised, then biological drugs are used (e.g. etanercept or adalimumab) and these are very effective.
All of these treatments need monitoring under the care of a specialist. Regular blood tests and in some cases regular ultrasound scans are required often.
Can a child live a full and active life like their peers?
Treatments these days are very effective. As a result, the long-term severe joint damage that used to be commonplace in JIA is no longer seen.
It’s highly likely that the child will be able to participate fully in both school and physical activity, despite having JIA. Therefore, it’s important that the child’s school knows about the condition so that they can facilitate the process of helping the child to lead a full and normal life.
Dr Joel David is a highly experienced rheumatologist who specialises in juvenile arthritis along with adult conditions such as rheumatoid and psoriatic arthritis. If you’d like to talk to him about joint issues concerning yourself or your child, don’t hesitate to book an appointment by visiting his profile.