Juvenile Arthritis: Diagnosis and Treatment Options for Your Child

When I tell people I’m a pediatric rheumatologist – which is a doctor who takes care of children with arthritis and autoimmune disorders, - nearly everyone responds, “I didn’t know kids could get arthritis.”

Arthritis is a common condition in children, affecting one in 250 kids. It is characterized by the swelling of a joint or by the loss of the normal range of motion of a joint accompanied by pain with movement. Pain alone in a joint does not mean that a child has arthritis.

Arthritis, by itself, is simply a symptom of an underlying condition, just as a cough may represent asthma or pneumonia. In childhood, arthritis is usually a result of the body fighting an infection. The immune system, which fights infections, can often mistake the proteins and parts that make up our joints as the same material that is seen in types of viruses and bacteria. As our body fights the infection, there can be a short period of time when inflammation/irritation from our body is accidentally fighting against our joints. Usually, as the infection goes away the arthritis does, too.

However, some children get a form of arthritis that does not appear to have a cause and instead of going away after a month or two, continues to affect the same, or more, joints. This is called Juvenile Idiopathic Arthritis (JIA), with idiopathic meaning that there is no clear cause identified. Roughly one in 1,000 children have JIA.

JIA is also from our body’s immune system fighting against its own joints. In this situation, however, the body cannot shut off this process by itself. JIA should not be mistaken for osteoarthritis, which many older people can have. Osteoarthritis is from the loss of the protective covers on the bones at the joints, which causes the bones to grind on one another.

Another misconception is that JIA is not rheumatoid arthritis. While there are many things that overlap with the adult form of rheumatoid arthritis, JIA is considered its own condition. In fact, JIA is actually a group of conditions that all share the same feature of arthritis.

Types of Juvenile Idiopathic Arthritis

• Oligoarticular – Patients have four or less joints affected by arthritis. This is more common in girls and often begins in early childhood.
• Polyarticular – Patients have five or more joints affected by arthritis. This is also more common in girls and can start early in childhood or in teenage years.
• Enthesitis Related Arthritis - The enthesis is the place where muscles and bones come together. Patients with this form can often have pain along tendons. They are also at risk for arthritis of their back, called spondyloarthritis. It is more common in boys and usually develops in adolescence.
• Psoriatic Arthritis – Patients who have psoriasis, a skin disease, or with a parent or siblings who have psoriasis may develop arthritis. This is more common in girls and can occur any time in childhood.
• Systemic Onset JIA – This is very different from the rest of the types of JIA where high, daily fevers and rashes are also present. This affects boys and girls equally and can occur at any time in childhood.

How is JIA diagnosed?

Diagnosis is based completely on a physical exam performed by a pediatrician or specialist. There are no tests or labs that can be used to make a diagnosis of JIA, however there are labs that help assist with the diagnosis. Labs can help determine the amount of inflammation in the body or show risk factors for other complications, such as uveitis which is inflammation of the eyes. X-rays are helpful only to be sure there is not something else going on that can result in swelling, such as a fracture or tumor.

How is JIA treated?

Treatment can vary considerably, but the overall goal is to reduce the amount of inflammation in the joints. This is usually done with medications that can be taken, some by mouth, but may include injections at home or infusions in the hospital. Arthritis can also be treated with steroid injections directly into the affect joint(s). All children with JIA also benefit from physical therapy and a healthy, active lifestyle complemented by a well-balanced diet that includes vitamin D and calcium to promote healthy bones.

Should my child be seen by a rheumatologist?

In general, JIA tends to be a gradual process, rather than a big change overnight. If your child has had unexplained swelling in one or more joints that continues over the course of several weeks with no sign of improvement, you should consider having them seen by their pediatrician and possibly referred to a rheumatologist. Also, if you have noticed your child limping, having difficulty using their fingers or wrists, or seems to be “stiff” as they move, with this being worse in the morning or after naps, you may also want to consider a referral. For more information on Nationwide Children’s Hospital’s Rheumatology Services, click here.