Arthritis - juvenile idiopathic

About juvenile idiopathic arthritis

Arthritis is a condition that causes pain and swelling in one or more of your joints. Juvenile idiopathic arthritis, also know as juvenile rheumatoid arthritis and juvenile chronic arthritis, is a form of arthritis that affects children under 16. Idiopathic means that there is no known cause. In the UK, between 10,000 and 15,000 children are affected by juvenile idiopathic arthritis.

Juvenile idiopathic arthritis is a chronic condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.

Types of juvenile idiopathic arthritis

Juvenile idiopathic arthritis is the most widely accepted term to describe different types of chronic arthritis in children. However, there are seven different types of juvenile idiopathic arthritis, as listed below.

  • Oligoarthritis is the most common type of juvenile idiopathic arthritis and the mildest. It usually affects one or both knees and is likely to clear up, leaving little damage to your child’s joints.
  • Polyarticular juvenile idiopathic arthritis can come on suddenly or affect more joints over several months. It’s the second most common type of juvenile idiopathic arthritis.
  • Extended oligoarthritis can develop after having oligoarthritis for six months. Your child may have problems with five or more joints.
  • Psoriatic arthritis is joint pain that accompanies psoriasis – a skin condition that causes a scaly rash. Your child’s joints may start to ache before the rash appears.
  • Enthesitis-related arthritis is a form of juvenile idiopathic arthritis that affects the areas where tendons of ligaments attach to bone (the entheses). It usually affects joints in your child’s legs and spine.
  • Undifferentiated arthritis is when your child’s symptoms don’t fit into one of the other categories or they fit into more than one category.
  • Systemic arthritis is the rarest type of juvenile idiopathic arthritis in which joint pain is part of a general illness.

Symptoms of juvenile idiopathic arthritis

The type of juvenile idiopathic arthritis your child has will be determined by the symptoms that he or she develops in the first six months. Symptoms can vary from day to day, with periods when they flare-up and get worse.

The most common symptoms for all types of juvenile idiopathic arthritis are swollen, painful and stiff joints that are usually worse in the morning. The joint areas may look red and feel hot to touch. The exact symptoms and number of joints affected will vary depending on which type of juvenile idiopathic arthritis your child has.

Children with polyarticular juvenile idiopathic arthritis will have at least five joints affected, including fingers and toes. Swelling and pain may also occur in the hips, neck and jaw. Your child may also have other symptoms, including:

  • nodules on his or her elbows – a nodule is a small, round mass or lump
  • a rash
  • a fever

As well as joint pain, children with systemic juvenile idiopathic arthritis may also have:

  • a fever
  • a rash
  • swollen glands
  • a lack of energy and tiredness
  • unexplained weight loss

Complications of juvenile idiopathic arthritis

Juvenile idiopathic arthritis may cause inflammation of your child’s eyes (uveitis). This can cause blurry vision or total loss of vision. Make sure your child has regular eye checks with an ophthalmologist (a doctor who specialises in eye health, including eye surgery). It’s important to tell your child’s doctor if there are any changes in your child’s eyes or vision.

Juvenile idiopathic arthritis may also affect your child’s growth. Overall growth is usually slower. However, depending on the severity of the condition and the joints that are affected, some bones may grow faster than others, causing one leg or arm to be longer than the other.

Your child may have trouble with his or her teeth, especially if their jaw is affected by juvenile idiopathic arthritis. If this happens, your child may need orthodontic treatment (the straightening or moving of teeth, to improve their appearance and how they work).

Causes of juvenile idiopathic arthritis

The exact cause of juvenile idiopathic arthritis isn’t understood at present, but it’s thought to be an autoimmune disorder that may be caused by genetic factors. This means that the immune system attacks the body instead of defending the body against infection and other harmful substances.

However, not all types of juvenile idiopathic arthritis are autoimmune disorders. Recently, research has suggested that some systemic arthritis is caused by auto-inflammation. Auto-inflammatory disorders are also caused by an overactive immune system, but the reason for the inflammation is unknown.

Diagnosis of juvenile idiopathic arthritis

Your GP will ask you about your child’s symptoms and examine him or her. Your GP may also ask you about your child’s medical history.

There’s no single test for juvenile idiopathic arthritis. Your child may need to have one or more of the following tests to help rule out other conditions and identify the type of juvenile idiopathic arthritis they have.

  • Blood tests are used to look for inflammation and antibodies. Antibodies are produced by your immune system when you’re ill to help fight against bacteria and viruses.
  • X-rays can show if there is any damage to your child’s joints.
  • An ultrasound, using sound waves, can produce an image of the inside of your joints.
  • An MRI scan uses magnets and radiowaves to produce images of the inside of your joints.
  • Aspiration of a joint – fluid from a swollen joint may be removed and sent to a laboratory to be tested for signs of infection.

Treatment of juvenile idiopathic arthritis

There isn’t a complete cure for juvenile idiopathic arthritis. The aim of treatment is to reduce swelling, maintain full movement of the affected joints, ease pain and prevent any complications.

Self-help

Regular exercise, such as swimming and running, may help ease symptoms. Eating a healthy, balanced diet and getting plenty of sleep can also help with growth and making bones strong.

See our FAQs for more information on following a healthy diet.

Physiotherapy

Physiotherapy plays an important part in the management of juvenile idiopathic arthritis. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will give your child exercises to do at home to help maintain flexibility, range of motion and joint function. Your child’s exercise plan may include:

  • muscle strengthening exercises
  • balance and co-ordination exercises
  • fitness training
  • stretches to muscles and joints
  • advice on ice therapy, heat packs and other pain relieving methods

Medicines

There are many different medicines available to help control symptoms, slow down or even stop the progression of juvenile idiopathic arthritis. Some examples are listed below.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen, can help ease pain, stiffness and swelling.
  • Painkillers – such as paracetamol, can help ease joint pain.
  • Steroids – such as prednisolone, can help ease severe swelling. They are usually given as tablets or as an injection into the affected joint.
  • Disease-modifying antirheumatic drugs (DMARDs) – such as methotrexate, can ease swelling and reduce joint damage. This type of drug is slow to take effect so your child may not notice any benefits for several months.
  • Etanercept – sometimes used if other medicines haven’t worked.
  • Eye drops – may be used if your child has uveitis.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Living with juvenile idiopathic arthritis

Most children with juvenile idiopathic arthritis are able to live a normal active life. For some, however, the symptoms may cause problems that make daily life difficult. Your child may find it difficult to bend, get dressed or even walk by themselves. There is a great deal of support available for children with juvenile idiopathic arthritis. As well as the team of healthcare professionals treating your child, there are support groups that can offer advice and information.

If my child has juvenile idiopathic arthritis, will he or she need to eat a special diet?

Answer

There is currently no evidence to suggest that following a special diet will help improve juvenile idiopathic arthritis.

Explanation

Although there is no evidence to suggest that any specific foods can improve the symptoms of juvenile idiopathic arthritis, it’s important that your child eats a healthy, balanced diet. Your child should aim to eat at least five portions of fruit and vegetables a day. It’s also important to limit the amount of sugary and fatty foods that your child eats. This is especially important if your child is not as active due to fatigue or lack of mobility.

Juvenile idiopathic arthritis can make some children feel very tired, so try to make sure that your child eats lots of foods that are high in protein. Protein will help with growth and development. Good sources of protein include turkey, fish and nuts.

It may be beneficial to incorporate calcium-rich foods into your child’s everyday diet, such as milk, cheese and yoghurt (low-fat ones are best). This can help your child’s bone health.

A dietitian can help plan a nutritious diet that will benefit your child, as well as the whole family.

Will my child need any special equipment if he or she has juvenile idiopathic arthritis?

Answer

It’s possible, but this will depend on how severe your child’s condition is.

Explanation

Most children with juvenile idiopathic arthritis are able to lead a normal life. However, you may need to make some changes to your home or at school to help your child manage his or her condition more easily. A desk that tilts can help to keep your child in a more upright posture. It’s important to inform your child’s school about juvenile idiopathic arthritis, as he or she may need to take time off to attend doctor’s appointments. Talk to your child’s teachers about possible considerations, such as allowing extra time to get around between lessons or to complete written work. It’s also important that teachers are aware that your child may be in pain, may not be able to sit cross-legged on the floor and may get tired easily.

Although most people with juvenile idiopathic arthritis have no problems with mobility, crutches may be useful if your child needs help with walking. A wheelchair is rarely needed, but may be of benefit if walking long distances becomes a problem. It’s important to remember that your child’s muscles will weaken if they aren’t being used, so it’s best to encourage him or her not to use a wheelchair as a replacement for mobility, but as an aid for longer journeys.

Splints can help to stabilise a joint, which may help to keep your child mobile for longer periods. Your child’s physiotherapist can give you more information about splints. A podiatrist (a health professional who specialises in conditions that affect the feet) may recommend having insoles made to support your child’s feet and ankles. This can help relieve pain in your child’s knees and hips.

Your child’s occupational therapist (a health professional who can give practical assistance to help your child manage with everyday tasks and increase their independence) can give you more information about equipment and adjustments at home or school.

If my child has juvenile idiopathic arthritis, does it matter if he or she forgets to take a dose of medicine?

Answer

This will depend on what medicine your child’s taking.

Explanation

It doesn’t matter if your child misses a dose of non-steroidal anti-inflammatory drug (NSAIDs), although their joints may be more painful and stiffer than usual. This will also be the case if your child is taking methotrexate and forgets to take a dose, but several missed doses can lead to a more serious relapse in symptoms. A missed dose should never be taken more that 24 hours later than planned. If you or your child remembers the missed dose later than this, don’t take it, just take the next one when it’s due. Always read the patient information that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.

If your child is taking steroids and forgets to take their medication, make sure he or she takes the missed dose as soon as possible. Several missed doses of steroids can cause serious symptoms, such as dizziness and pain in the abdomen (tummy). Always speak to your GP if your child has missed a dose of steroids. Steroids should only be stopped very gradually; otherwise there is a risk your child may have a serious relapse.