What Is Juvenile Idiopathic Arthritis (JIA)? Symptoms, Causes, Diagnosis, and Treatment
There are several different forms of JIA, but the most common are oligoarticular arthritis, which affects up to four joints in the body, and polyarticular, which affects more than four joints, says Anjali Sura, MD, an assistant professor of pediatrics at SUNY Upstate University Hospital in Syracuse, New York. There is overlap among the types of JIA, along with multiple subtypes, and lots of debate about new classifications, says Jay Mehta, MD, an associate professor of clinical pediatrics at the University of Pennsylvania Perelman School of Medicine and the fellowship director at Children’s Hospital of Philadelphia.
Currently, other types of JIA include:
There’s no solid answer right now about why JIA develops, experts say. Some families develop a collection of autoimmune conditions, though not usually the same ones, and JIA can be one of those diagnoses, says Dr. Sura. Other families have no history of any autoimmune disease when it is diagnosed.
Some believe JIA happens as a combination of genetics and some environmental triggers, says Dr. Mehta, “but we don’t know what they are. There are some genes that are identified as having a potential role, but not everyone with those genes gets arthritis, and not all with arthritis have those genes.”
JIA is diagnosed typically with magnetic resonance imaging (MRI) or ultrasound imaging, as well as testing for other diagnoses, such as Lyme disease, to rule out other causes as well as other forms of arthritis. Effective treatment depends on an accurate diagnosis.
With the availability of JIA medication known as biologics, the prognosis for people living with the condition is excellent, says Sura. With the right treatment, people with JIA can expect to have a full quality of life and maintain a full range of joint motion. Before these drugs became available in the early 2000s, people with JIA could experience permanent disability and/or needed joint replacement surgery.
Medication to treat JIA can have side effects, so ongoing bloodwork may be needed to ensure, for example, that liver function remains healthy. Most drugs to treat JIA are immunosuppressive, says Sura, so infection risk can be higher than someone not taking these drugs. “I haven’t seen any serious infections among my patients, but they may have a cold that lasts one day longer,” she says. “And with the pandemic and the registry of JIA patients being followed, they don’t seem to have worse rates of COVID or more severe cases of it.”
While some kids who are diagnosed with JIA grow out of it, others go into remission, where symptoms go away for a long period of time, while some live with ongoing issues such as rashes, fever, slow growth, osteoporosis, and worsening arthritis. Rarely, JIA can affect the organs and cause issues with the endocrine system, kidneys, or heart.
It depends on the type and age of person when diagnosed with JIA, but “in general, about one-third of all kids outgrow it, one-third go into remission for a few years, and one-third have the more chronic form where they flare and still have juvenile arthritis into adulthood,” says Sura.
With mild JIA symptoms, pain relievers and/or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are used to help patients feel better physically. Sura says that in about 30 to 40 percent of her patients, this treatment is sufficient. These drugs, however, don’t treat underlying joint damage if it exists.
Some patients with certain forms of JIA may also benefit from a short course of injected corticosteroid drugs. But if these treatments don’t stop joint pain or swelling or joint function does not improve, or if you have a form of JIA that is best treated with stronger medication, the next step is to choose a disease-modifying antirheumatic drug, known as a DMARD. Conventional DMARDs work to suppress the overall immune system, while biologic DMARDs target specific parts of the immune process. Either way, DMARDs can help slow or stop JIA’s joint inflammation and potential joint damage.
DMARDs such as methotrexate can cause some nausea or fatigue, and depending on the medication used, patients are prescribed a daily multivitamin and have their blood counts and liver monitored to watch out for side effects. Mehta says most of his patients do well on methotrexate.
The growth of DMARDs, particularly biologics, has helped change treatment guidelines for those with JIA. Previously, some people with JIA began taking high doses of steroids at an early age. This led to weakened bones, osteoporosis, and suppressed growth. Starting JIA treatment with biologic DMARDs helps avoid such complications.
In early 2022, however, the American College of Rheumatology published guidelines for nondrug treatments for all people living with JIA. These cover physical and occupational therapy as needed, eating a well-balanced and healthy diet as it relates to one’s age, and lab tests both before starting and during treatment with new JIA medication to determine if the drugs are effective. The ACR guidance also urges people with JIA and the people they live with to stay up-to-date on all recommended vaccinations, including annual flu shots and ongoing COVID-19 shots as directed by public health experts.
“What I tell families is that they are welcome to try diet interventions, but there are no randomized control studies for juvenile idiopathic arthritis,” says Mehta. “If something works, I’m super happy for them, but it has to be a complement to the standard-of-care medicines.” In other words, such therapies help when they supplement — but never replace — drug treatment.
Always speak with your child’s physician about what methods you may incorporate and in what capacity.
With the appropriate medication and other treatment, JIA can be well managed. When it is not, joint damage can occur. This can look like:
As an autoimmune condition, JIA occurs when the body wrongly attacks a normal part of itself thinking it’s being threatened. Similarly, people with JIA can experience other autoimmune conditions. They include:
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