What is juvenile arthritis?

Arthritis is inflammation and stiffness of the joints. When most people think of arthritis, they usually think of older adults. But, the fact is nearly 300,000 children and teens younger than 16 years old in the United States live with some form of juvenile idiopathic arthritis (also called juvenile rheumatoid arthritis). 

What is juvenile arthritis? 

Most types of juvenile idiopathic arthritis (JIA) are autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues and organs, in this case, the joints. “There is no definitive known cause for the condition but there are hypotheses suggesting genetic, infectious and environmental factors may be involved,” says Magdalena Cadet, MD, a New York–based rheumatologist and associate attending at NYU Langone Medical Center. 

Only a small percentage of juvenile idiopathic arthritis cases have been reported to run in families, but a sibling of someone with the condition has about 12 times an estimated risk of developing juvenile arthritis than that of the general population. Females are also at a higher risk of developing juvenile idiopathic arthritis, as they are with other rheumatic conditions. 

What are the symptoms of juvenile arthritis?

Symptoms of juvenile idiopathic arthritis begin before age 16, become chronic, and may include: 

• Joint inflammation, pain, and stiffness: Joint stiffness may be more apparent in the morning, or after periods of inactivity. You may also notice your child limping.
• Persistent fever
• Rash: A light pink skin rash may appear in conjunction with a fever.
• Swollen lymph nodes
• Eye problems: This can include uveitis (inflammation of the eye) or blurred vision.

“To receive an actual JIA/JRA diagnosis from a medical professional, the patient would need to experience recurring pain and display signs of joint swelling for at least 6 weeks,” says Lawrence Barnard, DO, board-certified neuromusculoskeletal specialist who works at MAXIM ReGen. According to Dr. Barnard, this time frame is important because “most children and teens experience growing pains throughout adolescence that are painful and quite distracting but aren’t actually a form of arthritis.” If juvenile arthritis is suspected, a pediatrician or general physician may refer the patient to a pediatric rheumatologist after considering factors such as family history. 

What are the types of juvenile arthritis?

“There are different classifications of JIA which can be based on numerous factors such as the number of involved joints, age of onset, presence of some autoimmune markers (positive or negative rheumatoid factor or antinuclear antibody), or other associated clinical features like fever, or eye involvement,” Dr. Cadet explains. 

There are six subtypes of juvenile idiopathic arthritis:

1. Oligoarthritis (the most common form): This form affects fewer than five joints for the first six months of the disease. It causes eye inflammation or uveitis/iritis and is more common in girls.
2. Polyarthritis: This form affects five or more joints on both sides of the body, is similar to adult rheumatoid arthritis, and is more common in girls.
3. Systemic arthritis: This form of arthritis can affect the entire body including internal organs and systems of the body. It often causes high fevers, rashes, and lymph node enlargement.
4. Enthesitis-related: This form causes inflammation where the tendons attach to the bone (entheses) as well as the fingers and toes. It typically affects older boys.
5. Juvenile psoriatic arthritis: This form causes reddish and scaly patches on skin. Back pain, joint pain, and nail abnormalities like nail pitting may be present.
6. Undifferentiated: This is the classification for patients who do not fit into other subtypes, or who fulfill the criteria for more than one type.

How is juvenile arthritis diagnosed?

Juvenile idiopathic arthritis can be difficult to diagnose and differentiate from other conditions. There is no definitive test for JIA, so doctors diagnose the condition based on medical history, a complete physical exam, and by ruling out other conditions. They may also order the following diagnostic tests.

• Rheumatoid factor test: Tests for the presence of an antibody produced by the immune system that can indicate the presence of a rheumatic disease.
• C-reactive protein test and/or erythrocyte sedimentation rate (ESR): These tests measure inflammation in the body.
• HLA-B27 test: This measures a genetic marker test for enthesitis-related JIA.
• Antinuclear antibody test: This test helps to show the presence of autoimmunity.
• MRI and/or X-ray: These scans help to rule out other conditions.

Several of these tests mentioned above can be positive in a normal child, hence the results should be interpreted by a physician to make a final diagnosis. 

“Eye screening is recommended for some subtypes of juvenile arthritis, and I would recommend that every child who is suspected to have this condition should have an ophthalmologist referral,” says Dr. Cadet. She says it’s crucial to have a “thorough evaluation in children before making a diagnosis of juvenile arthritis to exclude other medical conditions such as Lyme disease, lupus, bone disorders, fibromyalgia, infection, and cancer.”

How is juvenile arthritis treated?

Treatment of juvenile idiopathic arthritis is based on which type of arthritis a child has, and typically involves a combination of medication and exercise. “The goal of treatment is to reduce joint pain and swelling, prevent joint damage, and increase joint mobility,” says Dr. Cadet. She also notes that “sometimes these children do grow out of symptoms and go into remission with treatment,” but that others may progress and go on to develop adult rheumatoid arthritis.

Lifestyle changes

Some lifestyle remedies that may be helpful for juvenile arthritis include: 

• Exercise
• Healthy diet
• Physical therapy
• Heat treatment

Dr. Barnard says heat can help with inflammation and pain. “Warm baths can be particularly fun for children (just bring their favorite toys and make an event out of it!),” he says, “or using DIY rice sock bunnies for heat treatment.”

Medication

Medications may help the condition in three main ways: to manage pain, prevent the progression of the condition, and avoid growth problems. The available options include:

• Nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen): NSAIDs are prescribed to treat pain. “Parents must monitor for nausea, abdominal pain, bruising, and a potential increase in blood pressure or kidney problems with this medication,” Dr. Cadet says.
• Disease modifying agents (hydroxychloroquine, methotrexate, sulfasalazine): These medications target certain chemicals in the body causing inflammation. Side effects of these medications can be severe, so it’s important to take them as directed by a healthcare provider. 
• Biologic injections (Humira, Enbrel, Remicade, Cosentyx, Ocrevus): These medications come from living organisms and block immune pathways in cells.

“Obviously, the first and ‘easiest’ option is taking an anti-inflammatory, such as ibuprofen, to see if that mitigates the intensity of the pain and swelling,” Dr. Barnard says. “If that doesn’t help … the child will likely be encouraged to visit a physical or occupational therapist for mobility and strength training.” 

The best treatment plans are multimodal. Combining medication with “safe but consistent movement can really help loosen those joints, particularly if paired with targeted exercises that your physical therapist provides as ‘homework’ between sessions,” Dr. Barnard explains.

Therapy 

Living with arthritis can be hard on a child. Working with a therapist or support group can help alleviate the psychological effects of a chronic illness.

“It is crucial for parents and physicians to address the emotional and social effects of the disease,” Dr. Cadet says, as well as “find support for the children through psychological counseling or organizations like the Arthritis Foundation that advocate for children living with this chronic illness.”

Does juvenile arthritis go away?

There is no cure for juvenile arthritis, but the Arthritis Foundation says that with early diagnosis and aggressive treatment, remission is possible. They recommend “a well-rounded plan” that includes medication, physical activity, complementary therapies, and a healthy diet to treat and prevent flare-ups.