Juvenile idiophatic arthritis

Juvenile idiophatic arthritis

Juvenile idiophatic arthritis (JIA) is an autoimmune disorder, which causes joint inflammation (redness, heat, pain and swelling) and stiffness for more than six weeks in a child aged 16 or younger. Juvenile idiophatic arthritis is also called juvenile rheumatoid arthritis and is the most common chronic rheumatologic disease in children. The highest frequency of onset of this condition is in children between 1-3 years old and is most commonly seen at this age in girls with oligoarticular JIA and psoriatic arthritis. The main difference between children' and adult's arthritis is that more than half of the children' arthritis disappears when they grow up while adults with arthritis have it usually lifelong.


Causes of juvenile idiophatic arthritis

The causes of JIA are not deeply researched yet but it is known that one of the causes is due to genetics. The IL2RA/CD25 and the VTCN1 genes have been found in patients with JIA. Besides, it has been observed that JIA children with a certain genetic path, who get in contact with certain environmental factors (such as a virus) tend to develop JIA. A further cause of JIA lays in the continuous use of antibiotics but more research needs to be conducted.


Types of Juvenile idiophatic arthritis

The several types of JIA have been classified under the following categories:

Systemic-onset JIA

Persistent or extended oligoarthritis

Rheumatoid factor (RF) – positive polyarthritis

RF-negative polyarthritis

Psoriatic JIA

Enthesitis-related arthritis

Undifferentiated - The disease does not meet criteria for any of the other subgroups, or it meets more than one criteria (and therefore could be classified in a number of subgroups).


Symptoms of juvenile idiopathic arthritis

Children presenting juvenile idiophatic arthritis may have fever and anemia, and their heart, lungs, eyes and nervous system may be affected. The arthritis may come, last for several weeks, then go away and come back again although the symptoms may be less severe during the recurrent attacks.

Depending on the type of JIA, children may present several or some of the aboved mentioned symptoms. It is important to mention that symptoms can change from day to day or throughout a single day. The most common symptoms include joints that are warm to the touch, swelling and tenderness at joints, fever, rash, favoring one limb over another or limping, pain (often worse following sleep or inactivity), stiffness (specially upon waking in the morning), inability to bend or straighten joints completely, decreased physical activity, fatigue, sleep problems, swollen lymph nodes, reduced appetite and/or weight loss.


Diagnosis juvenile idiopathic arthritis

In order to find out the type of JIA the doctor will conduct a physical examination and consider the child's symptoms. If arthritis can not be found by means of the physical examination, a rontgen can be done (if only one jointis involved). Besides, some laboratory studies may be conducted such as blood tests, liver function tests, computed tomography, magnetic resonance imaging (MRI), ultrasonography, echocardiography, and nuclear imaging. Further studies include: dual-energy radiographic absorptiometry (DRA), arthrocentesis/synovial biopsy and pericardiocentesis.


Treatment of juvenile idiopathic arthritis

Since there is no cure for JIA, the treatment is related to control pain and improve quality of life. The treatment includes a proper nutrition, natural medication or drugs(in severe cases), exercise, eye care and dental care. It is very rare to use surgery when the illness is in an advanced stage to help with pain or joint function. Eye care is relevant specially for children with oligoarthritis because JIA can cause eye inflammation (also called uveitis) and vision loss. Uveitis does not present symptoms every time and it can appear even if arthritis flares are under control therefore it is highly recommended to periodically control the sight with an ophtalmologist. Dental care is important because JIA may affect the temporomandibular joint (jaw) causing pain, stiffness and altered growth. This situation makes brushing and flossing difficult. The dentist may recommend using assistive devices or rinses to help teeth and gums stay healthy. Further, some cases require the use of splints in order to keep the joints in the correct position and relieve pain and to correct a deformity in knees, wrists or fingers. Further, shoe inserts (ortholics) may help with differences in leg length and balance problems. The ortholics can be done by an orthopedist or physical therapist.