JULY is Juvenile Arthritis Awareness Month. Juvenile idiopathic arthritis (JIA), formerly called juvenile rheumatoid arthritis (JRA), is a disorder that causes chronic inflammation of the joints of children and teenagers.

There are several different types of arthritis that can affect young people, but JIA is the most common. JIA is usually diagnosed between the ages two and five years old, but the diagnosis can still be made in children as young as 18 months and up to 16 years, with the majority being females.

What causes JIA?

This is a question that unfortunately does not have a perfect answer. We know that in children with JIA, their immune system causes inflammation in joints but we are not sure why. It is likely that interactions among genetic factors, immune mechanisms and environmental exposures contribute to the development of JIA. Some children may have been exposed to an illness, a certain medication or something else in their environment that triggers the immune system. Once the immune system is activated it mistakenly attacks the body’s own joints. The trigger unfortunately is usually never identified, hence the term idiopathic which means no identifiable cause. Some children may be more likely to develop JIA because of the genes they inherited from their parents, but it has to be emphasised that parents not absorb blame for this because they would not be able to prevent it from developing.

What are the symptoms of JIA?

The symptoms of JIA may vary depending on the child’s age and the type of JIA. However, there are some symptoms that are common among all children. Typically there is swelling (which may be progressive), stiffness and varying degrees of pain in the knees, ankles, wrists, elbows and small joints in the hands and feet. This may cause the child to limp or have some other impairment in function depending on the joints affected. For example, some children may have difficulty holding a pencil or using a spoon or fork to feed themselves. The stiffness is usually worse in the morning or after being inactive for a long time, with improvement throughout the day or with activity. These symptoms should be present for at least six weeks before the diagnosis of JIA can be made. Some forms of JIA may have an associated fever (present for at least two weeks) and rash.

About 10-20 per cent of children with JIA will develop uveitis, which is a type of inflammation within the eye. Unfortunately, there are often no symptoms until the inflammation has already caused damage. To help catch and treat uveitis before there is damage, children with JIA need to see an ophthalmologist for frequent screening eye exams.

How is JIA diagnosed?

The diagnosis of JIA is made based on a careful review of the child’s symptoms as well as a physical examination. In some cases, blood tests and imaging (X-ray, ultrasound, MRI) may be needed to support the diagnosis or rule out other sinister illnesses that may resemble JIA, but it is important to know that there are no specific tests to make the diagnosis.

What are the treatment options for JIA?

The treatment of JIA is centred on controlling inflammation in joints, decreasing pain and preventing long-term disability such as permanent damage deformity of the joints. Treatment options include the use of anti-inflammatory drugs such as ibuprofen, alone or in combination with steroid injections into the affected joint(s). For many, treatment will require a medication that targets the immune system itself. There is ongoing research geared toward understanding immune system triggers and how they cause inflammation which has led to more targeted and specific treatment. Many of the newer medications work by helping the body block signals that lead to inflammation.

In addition to medicine, treatment of JIA often involves physical and occupational therapy. This can help a child regain their normal range of motion in joints. Physical therapy can also help strengthen muscles that may have weakened during the time of disuse.

JIA may cause frequent and prolonged school absenteeism which can affect school performance. As such, academic counselling and individualised education programmes may be necessary to mitigate gaps in education. Parents and patients may also need support and counselling to offset the financial burden and other psychosocial issues that may arise.

Does JIA ever go away?

For some children, yes. This is called remission. For some children, arthritis will go into remission only to come back months to years later. It is difficult to predict which children will go into permanent remission and which children will need to continue treatment into adulthood. Fortunately, advances in the treatment and monitoring of JIA have improved the prognosis for all children.

Dr Debra Hall Parkinson is a consultant paediatrician at The Paediatric Place. She can be contacted at (876) 616-6816 or 876-926-1365.