Juvenile Arthritis

Juvenile arthritis (JA) refers to any form of arthritis or an arthritis-related condition that develops in children or teenagers who are less than 18 years of age.

Impact of Juvenile Arthritis:

• Approximately 294,000 children under the age of 18 are affected by pediatric arthritis and rheumatologic conditions.  
• Ambulatory care visits for pediatric arthritis and rheumatologic conditions averaged 827,000 annually. 
• Juvenile arthritis is one of the most common childhood diseases in the United States.
• Arthritis and related conditions, such as juvenile arthritis, cost the U.S. economy nearly $128 billion per year in medical care and indirect expenses, including lost wages and productivity.

Common Symptoms of Juvenile Arthritis

• Pain, swelling, tenderness and stiffness of joints, causing limited range of motion
• Joint contracture, which results from holding a painful joint in a flexed position for an extended period
• Damage to joint cartilage and bone leading to joint deformity and impaired use of the joint
• Altered growth of bone and joints leading to short stature

Types of Juvenile Arthritis:

• Polyarticular juvenile rheumatoid arthritis (JRA) - or juvenile idiopathic arthritis (JIA) -  typically affects five or more joints and:
  • affects girls more frequently than boys
  • most commonly affects knees, wrists and ankles
  • can affect weight-bearing and other joints, including hips, neck, shoulders and jaw
  • often affects the same joint on both sides of the body
• Pauciarticular juvenile rheumatoid arthritis (JRA) - or juvenile idiopathic arthritis (JIA) -  affects typically four or fewer joints and:
  • usually affects the large joints: knees, ankles or wrists
  • often affects a joint on one side of the body only, particularly the knee
  • may cause eye inflammation (uveitis) which is seen most frequently in young
    girls with positive anti-nuclear antibodies (ANA)
• Systemic onset juvenile rheumatoid arthritis (JRA) - or juvenile idiopathic arthritis (JIA) -  can:
  • affect boys and girls equally
  • cause high, spiking fevers of 103 degrees or higher, lasting for weeks or even months
  • cause a rash consisting of pale, red spots on the child’s chest, thighs and sometimes other parts of the body
  • cause arthritis in the small joints of the hands, wrists, knees and ankles

Other Types of Juvenile Arthritis: 

• Juvenile Spondyloarthropies (ankylosing spondylitis, seronegative enthesopathy and arthropathy syndrome) are a group of diseases that involve the spine and joints of the lower extremities, most commonly the hips and knees.
• Juvenile Psoriatic Arthritis is a type of arthritis affecting both girls and boys that occurs in association with the skin condition psoriasis.
• Juvenile Dermatomyositis is an inflammatory disease that causes muscle weakness and a characteristic skin rash on the eyelids.
• Juvenile Systemic Lupus Erythematosus is an autoimmune disease associated with skin rashes, arthritis, pleurisy, kidney disease and neurologic movement.
• Juvenile Vasculitis is an inflammation of the blood vessels and can be both a primary childhood disease and a feature of other syndromes, including dermatomyositis and systemic lupus erythematosus. 

Causes of Juvenile Arthritis:

• The cause of most forms of juvenile arthritis is unknown, but it is not contagious and there is no evidence that foods, toxins, allergies or vitamin deficiencies play a role

Diagnosis of Juvenile Arthritis:

• There is no single test to diagnose juvenile arthritis.  A diagnosis is based on a complete medical history and careful medical examination. Evaluation by a specialist – either a pediatric rheumatologist or a rheumatologist – is often required.
• Laboratory studies including blood and urine tests are often needed to assist in a diagnosis of JA.
• Imaging studies including x-rays or magnetic resonance images may be needed to check for signs of joint or organ involvement in JA.

Management of Juvenile Arthritis:

• Management varies depending on the specific form of juvenile arthritis.
• Care by a pediatric rheumatologist is important for most forms of JA.
• The primary goals of treatment for juvenile arthritis are to control inflammation (swelling) , relieve pain, prevent joint damage and maximize functional abilities.
• Treatment plans for children usually include medication, physical activity, physical and/or occupational therapy, education, eye care, dental care and proper nutrition.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of medication used in juvenile arthritis to help control pain and inflammation (swelling).
• Corticosteroids such as prednisone can be taken orally to relieve inflammation or injected into joints that are inflamed.
• Biologic Response Modifiers (BRMs), such as anti-TNF drugs, are a class of drugs that inhibit proteins called cytokines. They must be injected under the skin or given as an infusion in the vein.
• Disease-modifying anti-rheumatic drugs such as methotrexate are often used in conjunction with NSAIDs to treat join inflammation and reduce the risk of bone and cartilage damage

-- Arthritis Foundation