Return to: Arthritis ACT, Pain Support ACT, Emerge ACT or Condition Information
About Juvenile Arthritis (JA)
JA is an inflammatory, autoimmune disease that affects the joints and sometimes the eyes, internal organs, and muscles, and is:
- diagnosed in children from 0 to 16yrs of age
- chronic ie continues for a long time.
The body’s immune system (its protective mechanism against infection) starts to mistakenly attack healthy cells of the body. This happens for reasons we don’t yet understand, possibly after being triggered by a virus or bacterial infection. The immune system fails to ‘turn off’ when the infection has been cleared producing ongoing joint inflammation called JA.
What causes JA?
The causes of arthritis in children are not yet fully understood. Research suggests that in some types of JA genetics may be involved. However, these conditions are not regarded as hereditary (passed from parent to child). If you have one child with JA, it does not mean that your other children will also develop the condition. Genetics are only one part of the puzzle and researchers continue to look for other factors. Climate, diet or emotional factors do not appear to play a role in the development of arthritis in children.
How is JA managed?
There is still no cure for JA but many children go into remission, meaning symptoms disappear for long periods, sometimes forever. Some children with JA may need to continue taking the medicines to control their arthritis into adulthood. The overall treatments for JA aim to:
- Prevent or slow damage to joints and/or progression of the illness
- Reduce symptoms including inflammation, stiffness and pain
- Assist your child’s normal growth and development, and ensure that they are able to get back to their usual activities and lead the most normal life possible
Managing JA will involve medical and physical therapies and need to ensure that all aspects of the child’s health, growth and development are monitored. Medical management of the condition will require medicines that are targeted at working on the underlying disease process (even if the child is seemingly symptom free, they may still have underlying disease activity that needs to be treated).
Medicines will play a major role in the management of JA. Medicines used to treat JA include:
- Pain relievers (analgesics)
- Non-Steroidal Anti-Inflammatories (NSAIDs)
- Disease Modifying Anti-Rheumatic Drugs (DMARDs)
- Corticosteroids
- Biologic DMARDs (bDMARDs)
Pain Management: A range of interventions including medicines, use of hot and cold treatments, relaxation and distraction techniques, deep breathing, massage, gentle stretching and exercise can assist in relieving pain.
Physical Activity and Exercise: It is important that your child remains as active as possible, every
day. This may mean finding physical 24 Finding out your child has arthritis activities or sports that they enjoy but that do not cause too much discomfort. Generally, non-contact sports will be best for children with JIA to reduce the risk of joint injury or damage. Low impact activities such as cycling, yoga or dance are ideal, as they do not place too much stress or strain on joints.
Sleep and Rest: Children with JA can struggle with tiredness and fatigue. Alternating between active and passive activities throughout the day can help your child to participate in their normal daily routines without Living with JA. An important skill for children with JA to learn is that of ‘pacing.’ This means actively managing their activities and activity levels to avoid unnecessary symptoms of their JA.
Healthy Eating: Children and teenagers need a healthy, balanced diet for normal growth and development. There is no evidence to suggest that any food or diet will cause or cure
arthritis, or cause disease flares in JA. Exclusion of certain foods or food groups may however may mean your child misses out on important nutrients, vitamins and minerals.
School: JA may affect a child’s ability to participate in school due to issues with mobility, seating arrangements, absences/late starts, difficulty completing tasks, unable to participate in sports, uniform restrictions. Working with teachers and schools to address these issues can help.
What are the symptoms of JA?
Symptoms of JA can include the following but keep in mind that everyone is different and not all children will have all these symptoms:
- Swelling and redness in the affected joint or joints
- The affected joint or joints may be warmer than normal
- Joint stiffness, especially first thing in the morning
- Pain (affected joints are usually but not always painful)
- Pain that may vary from day to day or even from one time of day to another e.g. may be painful in the morning but not in the afternoon
Some children may have:
- A persistent or intermittent rash
- A fever that comes and goes, often spiking at around the same time of day
- Fatigue that is not improved by sleep
For a small number of children, the only sign that they have JA could be uveitis – an inflammatory eye condition.
How is JA diagnosed?
There is no single test to diagnose JA. Instead, it involves a number of steps. These may include:
- Detailed health and medical histories of the child and their biologically related family members (where known)
- Physical examination of affected joint/s
- Laboratory tests e.g. blood tests (see next page)
- Other tests such as x-rays, ultrasound and/or scans of the joints
- Eye tests
The results of these tests will help in confirming a diagnosis of JA, or rule out any other possible causes for the symptoms your child is experiencing.
If your doctor suspects JA, your child should be referred to a rheumatologist (ideally a paediatric rheumatologist who specialises in children with arthritis) who would confirm the diagnosis and start treatment.
What are flares?
A flare is a period when JA symptoms worsen. This can be the result of triggers such as overexertion, stress, infection, poor sleep or the natural progression of the disease. How you experience a flare may vary depending on the type of arthritis and the trigger. Some triggers may be obvious. Flares can vary in intensity, duration and frequency, but they’re usually reversible — if treated promptly.
For some people, flares are an inevitable part of the arthritis journey. Although flares can be difficult to predict, there are some things that can be done to reduce their number and minimize long-term damage. Making a flare plan with your rheumatology team can also help.
If symptoms are severe or last for more than a few days then contacting the rheumatologist is recommended, who can prescribe additional medications or alter the regular medications until the flare subsides.
What are the types of JA?
1. Oligoarthritis
This is the most common type of JA, affecting 50-60% of children. It often begins in young children (under 5 years) and is more common in girls. Symptoms include: joint swelling and pain, with four joints or less affected. The child’s general health is not normally affected.
It usually affects large joints such as the knees and ankles, and typically does not affect the
same joints on both sides of the body. There is a risk of developing uveitis (inflammation of the eye).
2. Polyarticular
This type is divided into two groups, depending on whether the test for rheumatoid factor (RF) is negative or positive. Symptoms include:
- Inflammation of many joints, affecting the same joints on each side of the
body including fingers, toes, wrists, ankles, hips, knees, neck and jaw - Onset of symptoms may be sudden and typically the child feels unwell, tired, listless and may develop a slight fever
- Affects between 20-30% of children with JA and is more common in girls
3. Systemic Onset JA
This is the least common type of JA. The early symptoms appear as a general illness involving:
- Fevers that occur once or twice a day
- Pink-coloured rash anywhere on the body, which comes and goes swollen glands in the armpits, neck and groin
- Feeling tired with widespread aches and pains, although swollen joints may not appear for several weeks
4. Enthesitis-Related Arthritis (ERA)
Enthesitis refers to inflammation of the ligaments and tendons, which are attached to bones. may also be called juvenile spondylitis, juvenile spondylarthropathy, or seronegative-enthesopathyarthropathy syndrome.
ERA most commonly affects the spine, heel, hips, knees, and ankles is linked with an increased risk of acute uveitis, an inflammation of the eye that causes it to become red, painful and sensitive to light.
5. Psoriatic Arthritis (PsA)
The symptoms of psoriatic arthritis include joint pain in any number of joints. In addition this form of JA also involves the skin. This is usually seen as patches of scaly skin, called psoriasis. The skin symptoms can appear before or well after the joint symptoms develop, which may
mean your child is initially diagnosed with a different type of JA.