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What is Juvenile Idiopathic Arthritis? 

What is Juvenile Idiopathic Arthritis? 

Last Reviewed : 01/11/2021
What is Juvenile Idiopathic Arthritis? 

  • Juvenile Idiopathic Arthritis (JIA), earlier referred to as Juvenile Rheumatoid Arthritis (JRA), is the most widespread type of joint inflammation (arthritis) in children younger than sixteen years. JIA causes painful, swollen, and stiff joints. A few youngsters may encounter symptoms for just a couple of months, while others may have them for the remaining of their lives. 
  • JRA is a condition caused by the immune system of an individual’s body. This implies that the body erroneously detects a few of its cells and tissues as unfamiliar. The immune system, which normally helps to fight off microscopic organisms like bacteria/viruses, starts attacking the healthy cells. 
  • The disease course is highly variable. Recent data reveal that a substantial number of children diagnosed with JIA have active disease that persists into adulthood and results in functional limitation. Thus, the management of JIA has become more aggressive earlier in the course of disease to limit permanent disability.

 

JIA used to be called juvenile rheumatoid arthritis (JRA), but the name changed because it is not a kid version of the adult disease. The term “juvenile arthritis” is used to describe all the joint conditions that affect kids and teens, including JIA. The word “idiopathic” means unknown, and researchers aren’t sure why kids develop JIA. They believe that kids with JIA have certain genes, which are activated by a virus, bacteria or other external factors. Additionally, there is no evidence that allergies, foods, lack of vitamins or toxins cause this disease
The criteria for classification of Juvenile arthritis  have been developed to determine the incidence and frequency of JIA, comprehend its etiology and to allow for better understanding of their pathogenesis and treatment responses
 It has become progressively evident that numerous types of JIA have a distinctive etiology, pathogenesis, and natural history, which has prompted refinements in classification criteria eventually.


Types of Juvenile Idiopathic Arthritis:

  • Systemic onset JIA: It may affect more than one joint. Frequent fevers and skin rashes are the main symptoms of this type along with swelling of inner organs, comprising the heart, liver, spleen, and lymph nodules. This type of JIA is also referred to as Still’s disease. 
  • Oligoarticular JIA: This kind of JIA has an effect on one to four joints in the first half-year of the disorder. It is known to be persistent when no more than four joints are influenced after the initial half-year. However, if still the joints get damaged or are painful, then it would then be known as extended.
  • Polyarticular JIA: This kind of JIA will affect at least 5 joints (can be more) in the first half of the year. Blood tests for Rheumatoid Factor (RF) can determine if polyarticular JIA is RF+ or RF-.
  • Enthesitis-related JIA: In this type of JIA, a kid or a teenager under the age of 16 years suffers from both arthritis and enthesitis. This is an inflammation of the tissue where a bone meets a ligament or tendon. It frequently influences the hips, knees, and feet.
  • Psoriatic arthritis: In this type of JIA, children suffer from arthritis as well as a red, scaly skin disease called psoriasis. They may have symptoms like, swelling of fingers or toes and crumpling of fingernails.
  • Undifferentiated arthritis: This type of JIA either has a minimum of two symptoms of JIA as mentioned above or could either match no symptoms at all.

 

Causes of JIA:

The exact reason for the occurrence of JIA in children and teens is still unknown. Studies demonstrate that it is a disorder of the immune system. In such a condition, a gene, Human Leukocyte Antigen (HLA) complex that aids the defense cells of an individual's body is not able to differentiate between its own cells and foreign bodies. The immune system, which should shield the body from these unsafe intruders, rather is directed against healthy tissues and initiates inflammation. 


Signs and symptoms of JIA:
Pain: While probably a younger kid will not be able to complain about the painful joints, the parents may observe that their younger ones' limp — particularly in the mornings or after a short nap.
Inflammation: Swollen joints are quite usual in JIA and are mostly observed in bigger joints, for example, the knee.
Firmness: As the studies suggest, it is quite noticeable by most of the parents that their younger one tumbles more often, especially in the mornings or after prolonged inactivity.
Other Symptoms: Chills, high fevers, swelling of lymph nodules, and blemishes on the skin are a few symptoms of JIA, which is bad in the mornings and worse in the evenings.

 

Diagnosis:
According to the American College of Rheumatology (ACR), a child must have inflammation in one or more joints lasting for a period of at least six weeks, be under 16 years old, and have all other conditions ruled out to be diagnosed with JIA.  
 A medical history, physical examination, and blood tests help to make the correct diagnosis. 
C-reactive protein: C-reactive protein (CRP) is a protein produced by the liver, in response to any condition causing inflammation in the body. 
Erythrocyte sedimentation rate: Erythrocyte sedimentation rate (ESR) is a blood test, which also helps in the detection of the degree of inflammation in the body.
Anti-Nuclear Antibody (ANA) test: This test shows the proof of autoimmunity. It is even helpful in the prediction of children or teenagers, who are more prone to the development of diseases in the eye with JIA.
Rheumatoid factor: RF is an antibody that is periodically found in the blood of youngsters, who are suffering from JIA.
Imaging tests: The doctor may order imaging tests, such as CT scans, MRI, ultrasound, and X-rays, to look for signs of joint damage. 


Treatment:
Doctors prescribe different kinds of treatments to relieve the symptoms and to control the disease activity. They may recommend medications like “Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as Ibuprofen, such as Advil, Motrin, or Naproxen (Naprosyn or Aleve)” for a reduction in swelling as well as pain. 
Disease-Modifying Antirheumatic Drugs  (DMARDs) control disease activity, they suppress the immune system, so that it does not attack the joints. Traditional DMARDs like Methotrexate are most used for JIA. Biologics target certain steps or chemicals in the inflammatory process and may work more quickly than traditional DMARDs, they are self-injected or given by infusion in a doctor’s office.
Other treatment methods comprise of lifestyle changes such as exercising regularly at home or with the help of a physical therapist and having a well balanced and healthy diet. Low impact joint-friendly activities like walking, swimming, biking, and yoga are preferable. 
Many children will never need surgery with the availability of advanced treatments including biologics. But for children with severe disease, surgery can provide much-needed relief and restore joint function. 


Conclusion:
Juvenile Idiopathic Arthritis (JIA), earlier referred to as Juvenile Rheumatoid Arthritis (JRA), is the most widespread type of joint inflammation (arthritis) in children younger than sixteen years. A child must have inflammation in one or more joints lasting at least six weeks, and be under 16 years of age to be diagnosed with JIA. Generally, there is pain, swelling, stiffness, and warmth in the joints. There is a possibility of serious complications, such as eye inflammation, growth problems, and joint damage. Treatment focuses on relieving pain and inflammation, controlling disease activity, improving function, and preventing joint damage. JIA may be difficult to control and can progress in some children, but in most cases, can be well controlled with treatment.


References:
1.     Juvenile idiopathic arthritis - Symptoms and causes - Mayo Clinic [Internet].  Available from: https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/symptoms-causes/syc-20374082
2.     Ringold S. Classification of juvenile idiopathic arthritis. 2020. 
3.     Kimura Y. Systemic juvenile idiopathic arthritis: Clinical manifestations and diagnosis. 2020. 
4.     Juvenile Rheumatoid Arthritis | Johns Hopkins Medicine [Internet].  Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/juvenile-idiopathic-arthritis
5.     Juvenile idiopathic arthritis - Genetics Home Reference - NIH [Internet].   Available from: https://ghr.nlm.nih.gov/condition/juvenile-idiopathic-arthritis#synonyms
6.     Juvenile Idiopathic Arthritis (for Parents) - Nemours KidsHealth [Internet].   Available from: https://kidshealth.org/en/parents/jra.html
7.     Juvenile idiopathic arthritis - Diagnosis and treatment - Mayo Clinic [Internet].   Available from: https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/diagnosis-treatment/drc-20374088
8.     Juvenile Idiopathic Arthritis: Symptoms, Treatment, and More [Internet].   Available from: https://www.healthline.com/health/juvenile-rheumatoid-arthritis#treatment. 

 

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