Juvenile idiopathic arthritis (JIA) is a childhood disease that causes
inflamed, swollen joints. This makes joints stiff and painful. The term "juvenile idiopathic arthritis" is replacing the American "juvenile rheumatoid arthritis" and the European "juvenile chronic arthritis."
Some children with JIA
grow out of it after they get treatment. Others will need ongoing treatment as
There are several types of JIA.
Doctors don't really know what causes the
disease. But there are a number of things that they think can lead to it. These
Children can have one or many symptoms, such as:
In some cases these symptoms can be mild and hard for you
to see. A young child may be more cranky than normal. Or a child may go back to crawling
after he or she has started walking. Your child's joints may feel stiff in the morning. Or your child may have trouble walking.
Children with this disease
can also get inflammatory
eye disease. This can lead to permanent vision
problems or blindness if it's not treated. Eye disease often has no symptoms
before vision loss occurs.
Your doctor will ask
questions about your child's symptoms and past health and will do a physical
exam. Your child may also have blood tests and a urine test to look for signs
of the disease. If your child has the disease, these tests can help your doctor
find out which type it is.
Your child's treatment will be
based on the type of JIA he or she has, and how serious it is.
Even when JIA isn't severe, your child may still need long-term
treatment. To make sure that treatment is right for your child, work closely
with the medical team. Learn as much as you can about your child's disease and
treatments. Stay on a schedule with your child's medicines and exercise.
Take good physical care of yourself so that you can help your child through the more difficult periods of illness. Consider finding a support group of families who live with juvenile idiopathic arthritis. Your local chapter of the Arthritis Foundation can provide classes and support group information.
Learning about juvenile idiopathic arthritis:
Living with juvenile idiopathic arthritis:
The cause of
juvenile idiopathic arthritis (JIA) isn't well
understood. Most experts believe it is caused by a combination of things,
The most common symptoms of all forms of
juvenile idiopathic arthritis (JIA) include:
Even though pain is a common symptom of JIA, your child may not be able to describe the pain. Or he or she may
be used to the pain. To know if your child is in pain, look for changes such as stiff movements, rubbing a joint or muscle, or avoiding movement.
Other symptoms vary depending on
which type of JIA your child has.
Systemic JIA can cause fever spikes and rash.
Other conditions with symptoms similar
to JIA include
growing pains, overuse, injury, bone infection, and
certain inflammatory diseases. Many conditions can cause painful,
stiff joints in children. Most often, occasional joint pain in children is
related to an injury or aggravating factors, such as repetitive overuse in
sports activities. JIA is a fairly uncommon cause of these symptoms.
The course of
juvenile idiopathic arthritis (JIA) is unpredictable,
especially during the first few years after a child is diagnosed. JIA can be mild, causing few problems. It can get worse or disappear without
clear reason. Over time, the pattern of symptoms becomes more predictable. Most
children have good and bad days.
Of all children who have JIA, 3 or 4
out of 10 children will have long-term disability.1
Long-term disability may
range from occasional stiffness, the need for pain medicine, and limits on
physical activity to ongoing JIA and the need for major surgery such as
joint replacement. But for most adults who had JIA as children, any long-term
problems tend to be mild and don't affect their overall quality of life.
A child's long-term outlook depends on the type of JIA he or she has. For example, while a child with
oligoarticular JIA has a
good long-term outlook other than eye disease risk, a child with
polyarticular JIA or
systemic JIA has a greater chance of long-term problems.2
Treatment also affects the child's long-term outlook. If treatment is started early, there is less long-term disability, and the tissues may heal over time.2
Learn more about the symptoms and what happens in the types of JIA.
Complications associated with JIA
Some children with polyarthritis get arthritis in the
neck that can cause the neck bones to fuse together.
Complications of systemic JIA include heart or lung problems, such as
pericardial effusion. A rare lung complication is the
formation of scar tissue in the lungs (pulmonary fibrosis).
No clear risk factors for
juvenile idiopathic arthritis (JIA) are known at this
time. It may run in families.
Call your doctor immediately if:
Call your doctor if any of the following symptoms continue
for more than 2 days:
It can be hard to know when an infant has joint
pain. A young child may be unusually cranky or may revert to crawling after he
or she has started walking. You may notice gait problems with a walking child
or stiffness in the morning.
For a first check of joint pain and other
juvenile idiopathic arthritis (JIA), consult with
For more testing and disease management, consult
rheumatologist who specializes in children's rheumatic
disease (pediatric rheumatologist).
The disease management team
for JIA may also include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Findings from a physical exam,
including the pattern and nature of joint symptoms, are important keys to the
juvenile idiopathic arthritis (JIA). Lab tests may be used to support the diagnosis and make sure symptoms aren't caused by another health problem. JIA is often diagnosed only after other possible causes of symptoms have been ruled out and the pain and stiffness have lasted for at least 6 weeks.
Routine exams and
tests include the following:
The following tests are done if needed:
Your doctor will probably schedule routine checkups to see how your child is doing and how well treatment is working. This will include talking about inflammatory eye disease and exams for this disease, such as a slit lamp eye exam.
Treatment goals for
juvenile idiopathic arthritis (JIA) are to reduce your
child's joint pain and to prevent disability. Physical therapy and medicine are
the basis of medical treatment for JIA.
Treatment depends on the type and severity of JIA. Even when JIA is uncomplicated, an affected child may need years
of medical treatment or checkups. To make sure that your child's care is appropriate for the stage of disease, work
closely with the medical team. Learn as much as you can about your child's disease and treatments. And stay on
schedule with medicine and exercise.
Your doctor will set up a treatment team. It may include a pediatrician, an ophthalmologist, a rheumatologist, and a physical and/or
Treatment may include:
To learn more, see Home Treatment and Other Treatment.
likely be an important part of your child's treatment.
To learn more, see Medications.
Treatment depends on the type and severity of JIA. Even when JIA is uncomplicated, an affected child may need years of medical treatment or checkups. To make sure that your child's care is appropriate
for the stage of disease, work closely with the medical team. Learn as much as
you can about your child's disease and treatments. And stay on schedule with
medicine and exercise.
Inflammatory eye disease may develop in children with
JIA. This form of eye disease generally has no symptoms and can lead to
a permanent decrease in vision or blindness. So part of your child's treatment
plan should be regular checkups with an
Surgery may be used in a very small number of children with JIA who have severe joint deformity, loss of movement, or pain.
Some children with JIA have no appetite, so malnutrition becomes a medical concern. If
your child has little appetite for food, see a nutritionist for help.
The cause of
juvenile idiopathic arthritis (JIA) isn't well
understood, and there is no way to prevent it. But you can help prevent symptoms. See Home Treatment.
You can do a lot at home to help your child lead a normal life, relieve his or her symptoms, and prevent complications.
JIA often means making lifestyle
changes and adjustments. This can be frustrating and demanding for you, your
child, and your family. Here are a few steps to help yourself:
Most children with
juvenile idiopathic arthritis (JIA) need to take
medicine to reduce inflammation and control pain and to help prevent more
damage to the joints. When inflammation and pain are controlled, a child is
more willing and able to do joint exercises to improve joint strength and
prevent loss of movement.
Many different medicines are used to
treat JIA. No single medicine works for every child. Your doctor will try to find medicine that helps relieve symptoms and that has few side effects. This may take some time
Although treatment varies depending on the needs of each child, certain medicines are often tried first (first-line
medicines), while others are often saved to try later if they are needed
Gold salts were one of the first treatments used for
joint inflammation. You may still hear about them. But injected gold salts
have been replaced by methotrexate for the treatment of JIA. Gold salts taken
by mouth (oral) have not been shown to be effective for JIA.3
Some children with JIA gain significant benefit from early methotrexate
treatment, and this treatment is becoming
more common in an effort to prevent joint and eye damage. Early treatment with
methotrexate is often used for polyarticular JIA.1
Biologic therapy is a newer option to treat
JIA that doesn't respond to other treatments.
Biologics such as etanercept have had some success in relieving symptoms and decreasing the number of flare-ups.
Combination therapy—such as using methotrexate
with sulfasalazine, hydroxychloroquine, or etanercept—has been used on a
limited basis to treat JIA. Most medical experience with combination therapy is
with adults. Only children with severe JIA that has not improved with
methotrexate or sulfasalazine are considered for combination treatment.
Yearly flu shots are recommended
for children who are on long-term aspirin therapy. Children on long-term
aspirin therapy who get
chickenpox or the
flu are at risk for getting Reye
syndrome. Although there is a risk, Reye syndrome is very rare. Very few
cases have been reported in children with chronic arthritis
who were being treated with aspirin. If your child has been exposed to
chickenpox or the flu, talk to the doctor about giving your child acetaminophen to
control pain and relieve fever until the incubation period, or the illness
itself, has passed.
Surgical treatment may be used in a very small
number of children whose juvenile idiopathic arthritis (JIA) has caused severe
joint deformity, loss of movement, or pain.
The main things to think about for surgery during childhood are the child's age and whether his or her bones are still growing. If at all possible, joint reconstruction is delayed until
childhood bone growth is complete (at about 18 years of age).
When surgery to correct joint deformity is needed, the
more common procedures include:
Other surgical procedures for JIA are recommended only in selected cases. These include:
Other treatment for juvenile idiopathic arthritis (JIA) includes physical and
occupational therapy, healthy eating, pain management, and some complementary therapies.
Physical therapy will be an important part of
treatment if your child has severe JIA. The
physical therapist can help set up an exercise program
for your child, either for the child to do alone or to do with help from an
adult. Exercises should be done every day and should be regularly reviewed by the
physical therapist.3 The therapist will make sure that the
exercises are being done correctly. He or she can decide whether any exercises should be
added, dropped, or changed.
Occupational therapy helps a child live as independently as possible.
Any of the following may be used in physical or occupational therapy:
Healthy eating means eating a variety
of foods so that your child gets the nutrients he or she needs for growth and
development. Good nutrition may also help fight the effects of JIA. Your
child can eat all types of food as long as his or her weekly intake is balanced
Talk to your child's doctor about healthy foods for children with JIA. There are a few nutrients that may be helpful. These include:
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
CitationsHashkes PJ, Laxer RM (2005). Medical treatment of
juvenile ideopathic arthritis. JAMA, 294(13):
1671–1684.Nistala K, et al. (2009). Juvenile idiopathic arthritis. In
GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1657–1675. Philadelphia: Saunders
Elsevier.Giannini EH, Brunner HI (2005). Treatment of juvenile
rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp.
1301–1318. Philadelphia: Lippincott Williams and Wilkins. Murray MT, Pizzorno JE Jr (2006). Rheumatoid
arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 2089–2108. St. Louis:
Churchill Livingstone Elsevier.Other Works ConsultedBeukelman T, et al. (2011). American college of rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care and Research, 63(4): 465–482.Duffy CM, et al. (2005). Nomenclature and
classification in chronic childhood arthritis. Arthritis and Rheumatism, 52(2): 382–385.Goldmuntz EA, White PH (2006). Juvenile idiopathic arthritis: A review for pediatricians. Pediatrics in Review, 27(4): e24–e32.Simon L, et al. (2002). Treatment of pain in children
and older adults with arthritis. In Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2nd ed., chap. 5, pp. 119–129. Glenview, IL: American
Pain Society.Wilson D, Curry M (2011). The child with musculoskeletal or
articular dysfunction. In MJ Hockenberry, D Wilson, eds., Wong's Nursing Care of Infants and Children, 9th ed., pp. 1619–1688. St. Louis, MO: Mosby
June 5, 2012
Susan C. Kim, MD - Pediatrics & John Pope, MD - Pediatrics
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