Juvenile idiopathic arthritis (JIA) is an autoimmune disease which causes the tissue that lines the joints to swell. The tissue called synovium gets inflamed and leads to intense pain in the joints. The disease shows up in children between the ages of 6 and 16 and has no known cause as of now. In autoimmune diseases like this, the immune system of the body turns against the cells of the body and attacks them after identifying them as hostile.
Types – There are seven types are JIA that are recognized.
- Systematic Arthritis
Also called Still’s diseases, this affects the child’s entire body. It causes symptoms of high fever in the child which may increase around the evening and disappear. It can also cause rashes and make the child appear pale. Systematic arthritis is also known to affect internal organs of the body like the heart, spleen, liver and the lymph nodes. It can enlarge the lymph nodes and the spleen.
The condition is also called juvenile rheumatoid arthritis and affects the joints at the knee, ankle and the wrist. It does not affect more than five joints. Oligoarthritis can also affect the iris in the eye and is more common in girls than boys. Most children outgrow this condition as they grow older.
Polyarthritis – Rheumatoid Factor Negative
This condition is more common in girls than in boys and affects about to four or five joints. Joints on the hands and the other joints like knees, ankles, neck, feet and the hips, which bear weight may also be affected. It may also cause mild fever and subject the nodes in the body to pressure as the children sit or lean.
Polyarthritis – Rheumatoid Factor Positive
This variant of JIA exhibits itself like adult rheumatoid arthritis. The kids of this condition may be diagnosed with a protein called rheumatoid factor (RF) or a CCP antibody (anti-cyclic citrullinated peptide) in the blood. These kids may be more prone to risks of damage caused by erosions when compared to kids with other types of JIA.
In addition to arthritis, children also have a skin condition called psoriasis in this type of JIA. Psoriasis presents itself in the form of rashes on the elbows, knees, behind the ears, etc.) Very often, children are diagnosed with this even when they may not show evidence of the skin condition but they have a family member who has the condition. Such kids may have pitted nails on the fingers and the toes.
Children with this form of JIA suffer pain in the legs and the spine. It affects the places where tendons connect to the bones, also called entheses. The inflammation can cause pain in the hips, the back or their knees. This type of JIA often affects boys above the age of 8 who have a male relative with a history of ankylosing spondylitis or arthritis of the back.
The features of arthritis do not correspond with any of the mentioned categories or can be related to multiple types of arthritis.
What Are the Causes of Arthritis in Children?
Arthritis is an autoimmune disease and has currently no identifiable cause. However, scientists and researchers believe that it can be linked to the following factors.
- Environmental triggers or viruses may cause the immune system of the body to recognize the lining of the joints as a foreign body, thus attacking it. This causes inflammation in the joints.
- Certain infection may cause reactive arthritis which subsides after a few weeks. It hasn’t been found out whey the condition doesn’t subside in children who develop JIA.
- Children who have a family member with rheumatoid arthritis or other rheumatologically conditions have a higher chance of developing JIA. However, this does not indicate that it is genetically passed down.
Signs and Symptoms
The symptoms of arthritis in children are very vague and do not specifically indicate the presence of the condition. It is possible that children don’t show symptoms at all. Some of the probable symptoms of JIA are:
- Stiffness in the joints
- Swelling, pain, and tenderness at the joints
- Weight loss
- Blurred vision
- Redness or pain in the eye
- Lack of appetite
Diagnosis and Tests
Since there is no specific test for juvenile idiopathic arthritis, a form of eliminative diagnosis is conducted to rule out similar conditions like Lupus, bone disorders, fibromyalgia, etc. The doctor will require a complete medical history of your child and conduct a physical exam. Additional tests may also be performed to determine the type of arthritis in the kid.
Tests may include:
- Complete blood count test can check the red blood cells, the white blood cells and the platelets to determine the appearance and the amount of the cell type and narrow down on any specific medical condition.
- Blood culture is conducted to detect bacteria in the bloodstream which may be the cause of infections.
- Bone marrow biopsy is conducted to test for leukemia.
- Erythrocyte sedimentation rate is checked to see the rate at which the red blood cells fall to the bottom of the test tube. The rate is high in people suffering from conditions that cause inflammation.
- The level of C-reactive protein (CRP) is also checked. The liver releases this protein into the bloodstream if there is a chance for infection or inflammation. The level of this protein can also rise in the event of arthritis.
- Rheumatoid factor (RF) or cyclic citrullinated peptide antibody (CCP) are also tested for a specific kind of JIA. However, this is more common in adult arthritis.
- ANA (antinuclear antibody) is conducted to identify autoimmune diseases. It can also indicate if the child is likely to have eye diseases as a result of JIA.
- X-rays or an MRI of the joints are taken to check for bone damage.
- A bone scan may be done in the event of unexplained pain in the bone and the joints.
- An orthopedic surgeon may also perform a sampling of the joint fluid and the synovial tissue.
If symptoms of JIA are noticed in your child, it is essential that you take the child to a doctor and seek medical advice. Left untreated it can have the following complications.
- Severe damage to the joints.
- Limit growth. Certain medications prescribed for inflammation are also known to cause musculoskeletal problems in children.
- Inflammation of the eye called uveitis
- The eye condition, when not treated, can cause glaucoma, cataract or even blindness.
- Deformities in the joints of children who receive no treatment.
- A severe form of the condition, when not treated, can also lead to loss of hand function in the child.
Treatment and Management
Treatment of juvenile arthritis can include physical therapy, medication and a combination of exercises. The course of treatment is also dependent on the type and the severity of the condition.
Non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to relieve pain and inflammation in kids. These include Ibuprofen drugs like Advil, Motrin, etc. Dosage for these medicines is determined by the condition.
Corticosteroids may also be prescribed to treat instances of arthritic flares. However, it has side effects like slow growth, weight gain, skin changes, etc. Hence, it is usually not prescribed to children.
Disease-modifying anti-rheumatic drugs (DMARD) like methotrexate may be given in case the NSAIDs fail to relieve inflammation and pain. Hydroxychloroquine, sulfasalazine and TNF drugs that tumor necrosis factor may also be given to children with JIA.
There is also a new category of drugs called biologics that can be given to kids with JIA. Injections and IV infusions may be performed on a regular basis at the hospital.
- Physical Therapy
Physical therapy can help your child improve movement. The therapist will suggest certain exercises to reduce the stiffness in the joints, increase flexibility and improve strength in the child. Physical therapy exercises will be coined based on the specific condition of the child.
- Regular Exercise
A habit of regular exercise can help your child overcome a lot of pain and provide the support necessary to the joints. It can also improve motion in the joints. Warm-up activities and safe exercises like walking, swimming, cycling are recommended for children. You can also check with your doctor about any impact sports that your child needs to avoid due to the risk of serious injury. Timely treatment of juvenile idiopathic arthritis can help the child overcome pain and lead a relatively comfortable life. It is important that you track the development of the child and provide a nutritious and balanced diet to your child and aid in the recovery process
Dr. Rajesh Singh, Sr. Consultant Orthopedics & Joint Replacement Surgery at Brahmananda Narayana Multispeciality Hospital, Jamshedpur