Juvenile arthritis: a parent’s guide

Arthritis is a condition that we often associate with older people, but did you realise that children and young people can suffer from the condition too? Distinguished consultant paediatric rhuematologist Dr Vinay Shivamurthy explores the condition, explaining the early warning signs and the different types of the condition.

What is juvenile arthritis?

Juvenile arthritis is a chronic autoimmune condition. It's one of the most common inflammatory conditions that develop in children. In autoimmune conditions, the body makes antibodies against own body cells and in juvenile arthritis, the joints are primarily affected. Juvenile arthritis can affect children anywhere from the age of infancy up to the age of 16. We refer to this condition in young people as juvenile idiopathic arthritis; juvenile refers to younger children/young people and idiopathic means we do not know the exact cause.

What are the early warning signs of juvenile arthritis?

Juvenile arthritis can be dormant for a long time; many weeks, some months, and can subtly affect your joints without even you noticing anything significantly. The most common reason why people seek medical help is because of the pain they are experiencing. The usual description of any inflammatory arthritis such as juvenile arthritis is that children notice a pain, which is usually a dull aching pain, and they notice stiffness in the morning in the joints that are affected. This means that they have difficulty moving when they first wake up in the morning, or if they have been sitting for a long time. Some children may be unable to move certain joints because of the inflammation in the joints. Those are the common presenting symptoms.

Some other frequently occurring signs of juvenile arthritis include a difference in the appearance of the joints, a change in the gait, or struggling to do certain things, Some children may also experience difficulty in carrying out routine activities, such as dressing themselves, washing themselves or taking the stairs.

Are there different types of juvenile arthritis?

Yes, there are multiple types of juvenile idiopathic arthritis. The condition is heterogeneous, meaning there are different forms of arthritis. Unlike the adult form of arthritis, where there are distinctive types, such as rheumatoid arthritis, juvenile arthritis has different types.

The most prevalent type is oligoarthritis, which occurs when there are less than four joints. There are other subtypes, such as spondyloarthritis, which affects multiple joints are affected.

Another prevalent type is psoriatic arthritis, where a person may have psoriasis and arthritis or have arthritis associated with psoriasis, but not necessarily having skin lesions. In addition, systemic arthritis can be common. This type of arthritis generally consists of a fever, rash and gland swelling, with or without arthritis.

Furthermore, there are other arthritis conditions which may overlap more than one subtype or may not fit into one type of arthritis. Arthritis can also be associated with other autoimmune conditions such as lupus or vasculitis. However, with regards to juvenile arthritis, there are around seven different types.

Does juvenile arthritis hurt all the time?

When somebody has active arthritis, they may experience a persistent dull aching pain. At certain times it may hurt more, such as when they wake up in the morning. In other cases, the pain may not be necessarily purely with arthritis, it may be coming from the muscles that have gone weaker too.

As soon as arthritis has been treated, the pain usually tends to get better, but some pain may still persist. This can be due to the muscles which have gone weaker and have forgotten how to cope with the routine activities. The pain from the inflammation itself is only as long as the active arthritis is there; once we treat it, it should get better.

How do you treat juvenile arthritis? Is there a cure?

Unfortunately, there is no cure for juvenile arthritis, but what we have is many options to treat arthritis. One of these options is to bring it to remission, meaning that we can control the inflammation and the young person will not even notice that they have juvenile arthritis.

The treatment generally depends on how significant arthritis is, how many joints are affected and how badly it is affected. For example, if you have oligoarthritis, which is affecting only a few joints, such as knee or an elbow, we can treat it with anti-inflammatory medications such as ibuprofen or naproxen. In addition, we may choose to treat it with steroids. The steroids could be steroids by infusion, which means that we put a drip and give you some treatment in the initial phase, and then we switch to oral form for medication for a few days to a few weeks.

If only one or two joints are affected, we may suggest injecting straight into the joints that are affected without the need for steroid from mouth or by infusion, but if you have multiple joints arthritis, in addition to treating the initial period with either anti-inflammatory drugs or with the steroids or steroid injections, we may go for long-term medications such as methotrexate, what we call as disease modifying agents. In a small proportion of children, biologic agents are required, alongside medications such as methotrexate. These are medications synthesised in the lab against certain bad proteins that cause inflammation.

If your child is suffering from juvenile arthritis and you would like to book a consultation with Dr Shivamurthy, simply visit his Top Doctors profile today.