Juvenile Idiopathic Arthritis In Children

Juvenile Idiopathic Arthritis (JIA) is a type of arthritis that occurs in children. Arthritis causes swelling (inflammation) of the joints and stiffness of the joints. JIA is a type of arthritis that affects one or more joints in a child age 16 or younger for at least six weeks.

In contrast to adult rheumatoid arthritis, which is chronic and can last a lifetime, children frequently outgrow JIA. However, the disease can impair a child's bone development.

JIAs are classified into the following categories:

JIA with a systemic onset. This type is characterized by the involvement of one or more joints. There is frequently a high fever and a rash on the skin. Internal organs such as the heart, liver, spleen, and lymph nodes may also become inflamed. This is the least prevalent type. It affects approximately 1 in 10 to 1 in 7 children with JIA.

JIA in the oligoarticular region. During the first six months of disease, this type affects between one and four joints. After six months, if no additional joints are affected, this type is called persistent. After six months, if additional joints are affected, the condition is referred to as extended.

JIA involving multiple joints. Within the first six months of disease, this type affects five or more joints. Rheumatoid factor (RF) blood tests will determine whether this type is RF-positive or RF-negative.

JIA caused by enthesitis. This type causes both arthritis and enthesitis in children. This is an enlargement of the tissue at the junction of a bone and a tendon or ligament. It frequently manifests itself in the hips, knees, and feet.

Arthritis psoriatica. A child with this type may have both arthritis and psoriasis, a red, scaly skin disease. Alternatively, a child may have rheumatoid arthritis and two or more of the following:

  • A finger or toe is swollen or inflamed.
  • Fingernail pits or ridges
  • Psoriasis in a first-degree relative

Undifferentiated rheumatoid arthritis This is arthritis that exhibits symptoms consistent with two or more of the JIA types listed above. Alternatively, the symptoms may not be consistent with any type of JIA.


The following are the most frequently encountered signs and symptoms of juvenile idiopathic arthritis:

Pain. While your child may not complain of joint pain, you may notice him or her limping — particularly in the morning or following a nap.

Swelling. Swelling of the joints is common, but it is frequently first noticed in larger joints, such as the knee.

Stiffness. You may notice that your child appears to be more clumsy than usual, especially in the morning or following naps.

Fever, swollen lymph nodes and rash. High fever, swollen lymph nodes, or a rash on the trunk may occur in some cases — which is typically worse in the evenings.

Juvenile idiopathic arthritis may affect a single joint or a number of joints. Although juvenile idiopathic arthritis has several subtypes, the most common are systemic, oligoarticular, and polyarticular. Which type your child has is determined by their symptoms, the number of affected joints, and whether they have a fever or rashes.

As with other types of arthritis, juvenile idiopathic arthritis has periods of remission and periods of flare-ups.

When to consult a physician

Consult a physician if your child has had joint pain, swelling, or stiffness for more than a week — particularly if he or she also has a fever.


Juvenile idiopathic arthritis is a condition that occurs when the immune system of the body attacks its own cells and tissues. Although the reason for this is unknown, both heredity and environment appear to play a role.

Factors of danger

Certain types of juvenile idiopathic arthritis are more prevalent in females.


Numerous severe complications may occur as a result of juvenile idiopathic arthritis. However, by closely monitoring your child's condition and seeking appropriate medical attention, you can significantly reduce the risk of developing these complications:

Issues with the eyes. Certain types can cause inflammation of the eyes. If left untreated, this condition can progress to cataracts, glaucoma, and even blindness. Because eye inflammation frequently occurs without symptoms, it is critical for children with this condition to see an ophthalmologist on a regular basis.

Growth issues. JIA can impair your child's growth and bone development. Certain medications, most notably corticosteroids, can also inhibit growth.


Diagnosis of juvenile idiopathic arthritis can be challenging, as joint pain can be caused by a variety of different conditions. While no single test can definitively confirm a diagnosis, tests can assist in ruling out certain other conditions that exhibit similar signs and symptoms.

Tests of the blood

Several of the most frequently performed blood tests for suspected cases include the following:

  • Erythrocyte sedimentation rate (ESR). Sedimentation rate refers to the rate at which red blood cells sink to the bottom of a blood tube. An increased rate may be indicative of inflammation. The ESR is primarily used to assess the severity of inflammation.
  • C-reactive protein. This blood test, like the ESR, assesses the overall level of inflammation in the body.
  • Antinuclear antibody. Antinuclear antibodies are proteins that are frequently produced by the immune systems of individuals who suffer from certain autoimmune diseases, such as rheumatoid arthritis. They are a risk factor for developing eye inflammation.
  • Rheumatoid factor. This antibody is occasionally detected in the blood of children with juvenile idiopathic arthritis and may indicate an increased risk of joint damage.
  • Cyclic citrullinated peptide (CCP). As with rheumatoid factor, the CCP antibody may be detected in the blood of children with juvenile idiopathic arthritis and may indicate an increased risk of damage.

In many children with juvenile idiopathic arthritis, these blood tests will reveal no significant abnormality.

Scanners for imaging

X-rays or magnetic resonance imaging may be used to rule out other possible causes of the pain, such as fractures, tumors, infection, or congenital defects.

Following diagnosis, imaging may be used to monitor bone development and to detect joint damage.


The goal of treatment for juvenile idiopathic arthritis is to assist your child in maintaining a healthy level of physical and social activity. Doctors may employ a combination of strategies to alleviate pain and swelling, maintain full movement and strength, and avoid complications.


The medications used to treat juvenile idiopathic arthritis in children are chosen to alleviate pain, improve function, and prevent joint damage.

Typical medications include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, which include ibuprofen (Advil, Motrin, and others), and naproxen sodium (Aleve), help to alleviate pain and swelling. Consequences include upset stomach and, much less frequently, kidney and liver problems.

Disease-modifying antirheumatic drugs (DMARDs). Doctors prescribe these medications when nonsteroidal anti-inflammatory drugs (NSAIDs) alone do not relieve symptoms of joint pain and swelling or when there is a high risk of future damage. DMARDs are used in conjunction with nonsteroidal anti-inflammatory drugs (NSAIDs) to slow the progression of juvenile idiopathic arthritis. Methotrexate is the most frequently prescribed DMARD for children (Trexall, Xatmep, others). Nausea, low blood counts, liver problems, and a mildly increased risk of infection are possible side effects of methotrexate.

Biologic agents. Also known as biologic response modifiers, this newer class of drugs includes TNF inhibitors such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi), and infliximab (Remicade, Inflectra, others). These medications may aid in the reduction of systemic inflammation and the prevention of joint damage. They may be prescribed in conjunction with DMARDs and other medications. Other biologic agents, such as abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret), and tocilizumab, all work in slightly different ways to suppress the immune system (Actemra). Each biologic has the potential to increase the risk of infection.

Corticosteroids. Prednisone, for example, may be used to manage symptoms until another medication takes effect. They are also used to treat inflammation that occurs in areas other than the joints, such as the sac around the heart. Because these medications can impair normal growth and increase susceptibility to infection, they should generally be used for the shortest duration possible.


Your doctor may recommend that your child see a physical therapist to help maintain joint flexibility, range of motion, and muscle tone.

Additional recommendations from a physical therapist or occupational therapist regarding the best exercise and protective equipment for your child may be made.

Additionally, a physical or occupational therapist may recommend that your child wear joint supports or splints to help protect joints and maintain proper function.


To improve joint function in the most severe cases, surgery may be required.

Next steps

Tips to help you make the most of your child's healthcare provider visit:

  • Understand why you're paying the visit and what you hope to accomplish.
  • Prepare a list of questions you wish to have answered prior to your visit.
  • During the visit, take notes on any new diagnoses, medications, treatments, or tests. Additionally, take note of any new instructions your provider gives you regarding your child.
  • Understand why a new medication or treatment is being prescribed for your child and how it will benefit him or her. Additionally, be aware of the possible side effects.
  • Inquire about alternative treatment options for your child's condition.
  • Understand why a test or procedure is recommended and the possible implications of the results.
  • Understand what to expect if your child does not take the medication, undergoes the test, or undergoes the procedure.
  • If your child is scheduled for a follow-up appointment, jot down the date, time, and reason for the visit.
  • Understand how to contact your child's provider after regular business hours. This is critical if your child becomes ill and you require assistance or advice.
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