Juvenile arthritis: Signs and understanding

[5 MIN READ] 

In this article:

• Juvenile idiopathic arthritis (JIA) is the most common type of juvenile arthritis.

• The main treatments for JIA are intra-articular steroid joint injections.

• Parents can also adopt a whole-foods diet and make sure their child gets plenty of exercise and sleep.

Juvenile arthritis: Understanding signs and symptoms

In the United States, around 300,000 children have a form of juvenile arthritis (JA). In some cases, arthritis can cause more problems in children than in adults, because children’s bones are still growing and developing. We spoke with Brian Simmerman, M.D., division chief for general pediatrics at Providence Medical Group, and Rebecca Muntean, M.D., N.D., a rheumatologist at Providence Rheumatology in Spokane, Washington, about what JA is, how it is diagnosed and the best treatment options.

What is juvenile arthritis?

Juvenile arthritis is a group of inflammatory diseases that mainly affect the joints in children under 16 years of age. Many of those diseases are autoimmune, which means the body’s immune system attacks the child’s body, which can keep them from growing and developing normally.

Signs and symptoms of juvenile arthritis

The most common form of JA is juvenile idiopathic arthritis (JIA), and the main symptoms of JIA are stiffness and swollen joints. “Symptoms vary by the affected joints,” says Dr. Muntean. “With oligoarticular juvenile idiopathic arthritis (JIA), the knees and hips and mainly affected, which causes limping. With polyarticular JIA, it’s the hands, feet and neck, which means the child would have difficulty making fists. With system JIA, there are persistent fevers and anemia.”

Dr. Muntean stressed that “in general, pain is not a leading symptom in kids. If pain is a child’s main symptom, we will test them for other diseases, such as fibromyalgia, cancer or other pediatric joint diseases.”

Other common symptoms of JIA include:

• Rash
• Fatigue and tiredness
• Loss of appetite
• Growth problems
• Eye inflammation

Juvenile arthritis types

Juvenile idiopathic arthritis, which was formerly known as juvenile rheumatoid arthritis, is the most common type of juvenile arthritis. The word “idiopathic” means that its origins are not known. What researchers do know is that it refers to several different chronic disorders that involve inflammation of the joints. This can cause joint pain, joint swelling, warmth, joint stiffness and loss of motion.

There are six different types of JIA: 

• Systemic onset – affects one or more joints.
• Oligoarticular JIA – affects one to four joints in the first six months of the disease.
• Polyarticular – affects five or more joints in the first six months of the disease.
• Enthesitis-related arthritis – the child has arthritis as well as enthesitis, which is a swelling of the tissue where a bone meets a tendon or ligament.
• Psoriatic – the child has both arthritis and psoriasis, a skin disease.
• Undifferentiated – the arthritis has symptoms of two or more JIA types above.

The other, less common types of juvenile arthritis include:

• Juvenile myositis – an inflammatory disease that causes muscle weakness.
• Juvenile lupus – an autoimmune disease that affects the joints, skin and internal organs.
• Juvenile scleroderma – a group of diseases that cause the skin to tighten and harden.
• Vasculitis – a disease that causes inflammation of the blood vessels.
• Fibromyalgia – a chronic pain syndrome.  

The critical role of early diagnosis

It is especially important to diagnose a child with juvenile arthritis as early in the disease as possible, says Dr. Simmerman.

“Earlier diagnosis allows us to begin treatment that can improve symptoms,” he says, “but it also can help prevent side effects and complications such as vision problems, growth difficulties, joint complications of that particular disorder, and also preserve joint function.”

Dr. Muntean stresses that early intervention can particularly help prevent deformities, such as longer or shorter legs, a small jaw, hand and feet deformities and short stature.

Treatment options and management strategies

The first step when a child is diagnosed with juvenile arthritis is to bring them to a pediatric rheumatologist as soon as possible. This type of specialist stays up to date with all the latest research and treatment options.

According to Dr. Muntean, the main treatments for JIA are intra-articular steroid joint injections. “These types of injections quiet down the inflammation fast and prevent deformities,” she says. “There are many great, safe options for treatment.”

Parents can also make significant lifestyle changes to manage their children’s symptoms, such as:

• Adopting a whole-foods diet for the family.
• Helping their child stay active to improve their range of motion.
• Making sure they get good-quality sleep.
• Seeking counseling if the child suffers from depression or anxiety related to their symptoms.

 Dr. Muntean says it’s also important to have regular examinations that screen for uveitis, a type of inflammation inside the eye.

Supporting your child with juvenile arthritis

It’s extremely important, Dr. Muntean says, for parents to educate themselves about the disease so they can give their child every resource possible.

Dr. Simmerman adds that parents should also actively bolster their child’s self-esteem. “You should work to ensure that the child feels normalized, and not diminished, in their abilities,” he says. “Maintain routine daily experiences, ensuring adequate exercise and physical activity. Movement is good for all children, but it’s especially important for children with juvenile arthritis.”

Contributing caregivers

Brian Simmerman, M.D., is division chief for general pediatrics at Providence Medical Group.

Rebecca Muntean, M.D., N.D., is a rheumatologist at Providence Rheumatology in Spokane, Washington.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.