Juvenile Arthritis

Background

Juvenile arthritis (JA) is a term used to describe arthritis in children. Arthritis is caused by inflammation of the joints. This can cause joint pain, swelling, stiffness and loss of motion. Children can develop almost all types of arthritis that affect adults. The most common type that affects children is juvenile idiopathic arthritis. Both juvenile idiopathic arthritis (JIA) and juvenile rheumatoid arthritis (JRA) are classification systems for chronic arthritis in children. The JIA and JRA classification systems are necessary because different types of arthritis in children may have characteristic symptoms. This is important for doctors to understand when they are selecting the best treatment option for a child with JA.

JA affects children of all ages and ethnic backgrounds. There are nearly 294,000 children in the United States under age 18 that have arthritis or other rheumatic conditions.

Causes

Autoimmune disorders are the most common cause of JA. The body’s immune system normally helps to fight off bacteria or viruses. If a child has an autoimmune disorder, the body mistakenly attacks some of its own healthy cells and tissues. Inflammation may occur as a result and lead to pain, swelling, stiffness and loss of motion in the joints. Doctors are not sure why the immune system attacks healthy tissues in children who develop JA. They believe it may be due to a couple of reasons. There may be something in the child’s genetic makeup that gives them a tendency to develop JA. In those children, an environmental factor — such as a virus — may trigger the development of the disease.

Symptoms

The most common symptoms of JA are joint swelling, pain and stiffness that does not go away. JA typically affects the knees, hands and feet. It is usually worse for children in the morning or after a nap. There may be times when symptoms get better or go away. This is called remission. However, there are other times when symptoms may get worse. These are called flares. JA is different for every child. Some children may have just one or two flares and never have symptoms again. Other children may have many flares, or even symptoms that never go away.

Additional symptoms can include:

  • Limping because of a stiff knee
  • Excessive clumsiness
  • High fever and skin rash
  • Swelling in the lymph nodes in the neck and other parts of the body
  • Eye inflammation
  • Growth problems

Diagnosis

No single test can be used to diagnose JA. This can often be challenging for doctors. A doctor may suspect a child has JA if they have constant joint pain, swelling, unexplained skin rashes, fever and swelling of the lymph nodes. The different tools a doctor uses to help diagnose JA include:

  • Physical exam
  • Symptoms
  • Family history
  • Lab tests
  • X-rays

Treatment

Specialty drug list

The goals of treatment for JA are to relieve pain, reduce swelling in the joints and maintain joint movement. Doctors who treat arthritis in children know the importance of making sure the child can stay involved in social activities and have a good quality of life.

Doctors use a variety of approaches to treat JA. These are often used in combinations and at different times during the course of the disease. The most commonly used treatments are:

Nonsteroidal anti-inflammatory drugs (NSAIDs)
These medications are often the first type of medication used to treat a child with JA. Some children seem to respond better to one NSAID than another. Examples of NSAIDs are aspirin, ibuprofen and naproxen.
Disease-modifying anti-rheumatic drugs (DMARDs)
This type of medication is often used in children who do not respond to NSAIDs. There are many different types of DMARDs. Methotrexate, however, is most commonly used because it has been found to be safe and effective in children with JA whose symptoms are not relieved by other medications.
Corticosteroids
Children who have severe JA may require corticosteroids because they are stronger medications that help control serious symptoms. Prednisone is a common type of corticosteroid that is often given to manage these symptoms.
Biologic agents
This is a newer class of drug treatments that is given to children with JA who have not had any relief from other drugs. They help reduce inflammation and structural damage to the joints.

Side Effects

Treatment can cause side effects, but it is important that a child never changes their dosage or stops taking their medication. A doctor or pharmacist should be informed if bothersome side effects occur. Common side effects for the different treatment options for JA include:

NSAIDs
Nausea, vomiting, heartburn, diarrhea and headache
DMARDs
Nausea, vomiting, diarrhea, weakness, liver damage and increased risk of developing an infection
Steroids
Weight gain, increased appetite, anxiety, nervousness and increased risk of developing an infection. Steroids may also interfere with normal growth in children.
Biologic therapy
Cough, nausea, vomiting, rash, weakness, abdominal pain and increased risk of infection

Resources

There are many resources and organizations available to help, providing support, advocacy and information:

Arthritis Foundation

American College of Rheumatology

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

References

Centers for Disease Control and Prevention. http://www.cdc.gov/arthritis/basics/childhood.htm. Accessed December 22, 2011.

National Institutes of Health. NIAMS. http://www.niams.nih.gov/health_info/juv_arthritis/juvenile_arthritis_ff.asp. Accessed November 29, 2011.

National Institutes of Health. NIAMS. Handout on Questions and Answers about Juvenile Arthritis. NIH Publication No. 07-4942. Online version updated September 2011.