Juvenile idiopathic arthritis (JIA), an autoimmune disease, impacts one in 1,000 children in the United States. While that stat may seem low, it is the most common type of arthritis in children.
In 2023, Arkansas Children’s Hospital in Little Rock (ACH) treated 245 pediatric patients with JIA in its rheumatology program.
Lina Al-Jaberi, M.D., a pediatric rheumatologist at ACH and assistant professor in the division of pediatrics and the division of rheumatology at the University of Arkansas for Medical Sciences (UAMS), said medical experts in the rheumatology program take a “team” approach to treating JIA.
“We have exceptional expertise in treating JIA. We are part of the
PR-COIN (Pediatric Rheumatology Care and Outcomes Improvement Network) for JIA, so we have our own registry for patients with JIA,” Al-Jaberi said. “We use the most recent medications to treat JIA. We have a specialized JIA clinic two Fridays a month to provide comprehensive care to patients with arthritis.”
Al-Jaberi discussed the following five questions parents should ask about JIA:
1. What is juvenile idiopathic arthritis (JIA)?
Juvenile idiopathic arthritis (JIA) is a form of arthritis impacting children ages 16 or younger. It causes inflammation and stiffness in the joints for more than six weeks. If symptoms begin after 16 years old, it is called early-onset rheumatoid arthritis.
The number of affected joints and other associated symptoms characterize different subtypes of JIA:
- Oligoarticular JIA: Four or fewer joints involved, impacts bigger joints; This type of JIA typically begins with toddlers and has the highest risk of uveitis, silent inflammation in the eyes.
- Polyarticular JIA: Five or more joints involved, impacts smaller joints; About 30 to 40% of children that are diagnosed with JIA have this type.
- Psoriatic arthritis: Children who have a personal or family history of psoriasis may experience this type of arthritis. Children with psoriatic arthritis may also experience dactylitis, which is swelling that involves an entire finger or toe.
- Enthesitis-related arthritis: Impacts more of the lower extremities and enthesis, where the tendons attach to the bone; It is the only subtype that can cause eye inflammation where it is not silent but causes redness and pain. It is also the only subtype of JIA affecting boys more than girls.
- Systemic JIA: In addition to joint symptoms, it causes systemic inflammation like fever, swollen lymph nodes and rash.
2. What causes JIA?
It is an autoimmune disease, meaning the immune system mistakenly attacks the joints, causing inflammation. There is no known cause for JIA, but a combination of genetics and environmental factors can point to its cause.
3. What are common JIA symptoms?
Symptoms of JIA include:
- Swollen, stiff and painful joints, typically in the morning, after a nap or sitting for a long time
- Warmth to the joints
- Decreased use of one or more joints
- Fatigue
- Decreased appetite
- Poor weight gain
- Slow growth
- Some types can include uveitis
4. How is JIA diagnosed?
There are no diagnostic tests to diagnose JIA. Medical experts diagnose it based on a physical exam and symptoms, including joint inflammation, over six weeks. Some blood tests can help diagnose, but tests don't necessarily have to be positive. Common blood tests include ANA (Antinuclear Antibody), complete blood count, inflammatory markers and rheumatoid factor test.
Testing can also include joint fluid analysis (when fluid is drained from the joints), X-ray, MRI and ultrasound.
5. How is JIA treated?
There is no cure for JIA. Though some patients do outgrow JIA, depending on the subtype, it often persists into adulthood.
JIA treatment aims to reduce pain and stiffness, prevent deformities and help a child maintain a normal, active lifestyle. Because of this, treatment can vary for each child. Long-term prognosis has improved dramatically over the past few decades thanks to newer medications.
Treatments can include:
- Anti-inflammatory medications to reduce pain and inflammation
- Steroid injections into the joint
- Disease-modifying antirheumatic medications (DMARDs), like methotrexate
- Biologic medications, like infliximab and etanercept, improve arthritis symptoms throughout the body
- Physical therapy to improve or maintain muscle and joint function
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