Juvenile Idiopathic Arthritis
What is juvenile idiopathic
Juvenile idiopathic arthritis (JIA) is a form of arthritis in children. Arthritis
causes joint swelling (inflammation) and joint stiffness. JIA is arthritis that
affects one or more joints for at least 6 weeks in a child age 16 or younger.
Unlike adult rheumatoid arthritis, which is ongoing (chronic) and lasts a lifetime,
children often outgrow JIA. But the disease can affect bone development in a growing
There are several types of JIA:
JIA. This type affects one or more joints. There is often a high
fever and a skin rash. It may also cause inflammation of internal organs, including
the heart, liver, spleen, and lymph nodes. It is the least common type. It affects 1
in 10 to about 1 in 7 children with JIA.
JIA. This type affects 1 to 4 joints in the first 6 months of
disease. If no more joints are affected after 6 months, this type is called
persistent. If more joints are affected after 6 months, it is called extended.
JIA. This type affects 5 or more joints in the first 6 months of
disease. Blood tests for rheumatoid factor (RF) will show if this type is
RF-positive or RF-negative.
JIA. With this type, a child has arthritis as well as enthesitis.
This is a swelling of the tissue where bone meets a tendon or ligament. It often
affects the hips, knees, and feet.
arthritis. With this type, a child may have both arthritis and a
red, scaly skin disease called psoriasis. Or a child may have arthritis and 2 or
more of the following:
- Inflammation of a finger or toe
or ridges in fingernails
first-degree relative with psoriasis
arthritis. This is arthritis that has symptoms of 2 or more JIA
types above. Or the symptoms might not match any type of JIA.
What causes juvenile idiopathic
Like adult rheumatoid arthritis, JIA is an autoimmune disease. This means the
body's immune system attacks its own healthy cells and tissues. JIA is caused by
several things. These include genes and the environment. This means the disease can
run in families, but can also be triggered by exposure to certain things. JIA is
linked to part of a gene called HLA antigen DR4. A person with this antigen may be
more likely to have the disease.
What are the symptoms of
juvenile idiopathic arthritis?
Symptoms may appear during episodes (flare-ups). Or they may be ongoing (chronic).
Each child’s symptoms can vary. Symptoms may include:
- Swollen, stiff, and painful joints in the knees, hands, feet, ankles,
shoulders, elbows, or other joints, often in the morning or after a nap
- Warmth and redness in a joint
ability to use one or more joints
- Decreased appetite, poor weight gain, and slow growth
- High fever and rash (in systemic JIA)
- Swollen lymph nodes (in systemic JIA)
These symptoms can seem like other health conditions. Make sure your child sees his
or her healthcare provider for a diagnosis.
How is juvenile idiopathic
Diagnosing JIA may be difficult. There is no single test to confirm the disease.
Your child’s healthcare provider will take your child’s health history and do a
physical exam. Your child's provider will ask about your child's symptoms, and any
recent illness. JIA is based on symptoms of inflammation that have occurred for 6
weeks or more.
Tests may also be done. These include blood tests such as:
- Antinuclear antibody (ANA) and other antibody tests. These tests
measure blood levels of antibodies that are often seen in people with rheumatic
- Complete blood count (CBC). This test checks for low counts of red
blood cells, white blood cells, and platelets.
- Complement test. This test is done to measure the level of complement.
This is a group of proteins in the blood that help destroy foreign substances.
Low levels of complement in the blood are linked to immune disorders.
- Erythrocyte sedimentation rate (ESR or sed rate). This test looks at
how quickly red blood cells fall to the bottom of a test tube. When swelling and
inflammation are present, the blood's proteins clump together and become heavier
than normal. They fall and settle faster at the bottom of the test tube. The
faster the blood cells fall, the more severe the inflammation.
- C-reactive protein (CRP). This protein shows up when inflammation is
found in the body. ESR and CRP show similar amounts of inflammation. But one may
be high when the other is not. This test may be repeated to check a child’s
response to medicine.
- Creatinine. This is a blood test to check for kidney disease.
- Hematocrit. This measures the number of red blood cells in a blood
sample. Low levels of red blood cells (anemia) are common in people with
inflammatory arthritis and rheumatic diseases.
- Rheumatoid factor (RF). This test checks to see if RF is in the blood.
This is an antibody found in the blood of most people who have rheumatoid
arthritis and other rheumatic diseases.
blood cell count. This measures the number of white blood cells in the
blood. Higher levels of white blood cells may mean an infection. Lower levels
may be a sign of some rheumatic diseases or a reaction to medicine.
Your child may also have imaging tests. These can show how much damage the bones
have. The tests may include:
- X-rays. This test uses a small amount of radiation to make images of
organs, bones, and other tissues.
scan. This uses a series of X-rays and a computer to make detailed
images of bones, muscles, fat, and organs. CT scans are more detailed than
- MRI. This test uses large magnets and a computer to make detailed
pictures of organs and structures in the body.
scan. This uses a small amount of radiation to highlight the bones in a
Other tests may include:
tests. These look for blood or protein in the urine. This can mean the
kidneys are not working normally.
aspiration (arthrocentesis). A small sample of the synovial fluid is
taken from a joint. It's tested to see if crystals, bacteria, or viruses are
- Full eye exam done by an ophthalmologist
How is juvenile idiopathic
The goal of treatment is to reduce pain and stiffness, and help your child keep as
normal a lifestyle as possible.
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
Treatment may include medicines such as:
- Nonsteroidal anti-inflammatory medicines (NSAIDs), to reduce pain and
- Disease-modifying antirheumatic medicines (DMARDs), such as methotrexate, to
ease inflammation and control JIA
- Corticosteroid medicines, to reduce inflammation and severe symptoms
- Medicines called biologics that interfere with the body's inflammatory
response. They are used if other treatment isn’t working.
Talk with your child’s healthcare provider about the risks, benefits, and possible
side effects of all medicines.
Other treatments and lifestyle changes may include:
- Physical therapy, to improve and maintain muscle and joint function
- Occupational therapy, to improve ability to do activities of daily living
- Nutrition counseling
- Regular eye exams to find early eye changes from inflammation
- Regular exercise and weight control
- Getting enough rest
- Learning to use large joints instead of small joints to move or carry
What are the complications of
juvenile idiopathic arthritis?
Nearly half of all children with JIA recover fully. Others may have symptoms for
years. Some will have rashes and fever. Others may have arthritis that gets worse.
Problems may include slow growth and thinning bones (osteoporosis). In rare cases,
there may be problems with the kidneys, heart, or endocrine system.
Helping your child live with
juvenile idiopathic arthritis
Help your child manage his or her symptoms by sticking to the treatment plan. This
includes getting enough sleep. Encourage exercise and physical therapy and find ways
to make it fun. Work with your child's school to make sure your child has help as
needed. Work with other caregivers to help your child take part as much possible in
school, social, and physical activities. Your child may also qualify for special
help under Section 504 of the Rehabilitation Act of 1973. You can also help your
child find a support group to be around with other children with JIA.
When should I call my child’s
Tell the provider if your child's symptoms get worse or there are new symptoms.
Key points about juvenile
- JIA is a form of arthritis in children ages 16 or younger. It causes joint
inflammation and stiffness for more than 6 weeks.
disease may affect a few joints or many joints. It may cause symptoms all over
most common symptoms include swollen, stiff, warm, red, and painful joints.
- Treatment options include medicines, physical therapy, healthy eating and
exercise, eye exams, and rest.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
the visit, write down the name of a new diagnosis, and any new medicines,
treatments, or tests. Also write down any new instructions your provider gives
you for your child.
why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
if your child’s condition can be treated in other ways.
why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test
your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is
important if your child becomes ill and you have questions or need advice.
Online Medical Reviewer:
Diane Horowitz MD
Online Medical Reviewer:
Raymond Kent Turley BSN MSN RN
Date Last Reviewed:
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