Tips for parents: How to spot juvenile arthritis in your kids

Arthritis is the inflammation of the joints, and while it’s a condition that we usually associate with the elderly, there are in fact several types of arthritis that can affect the younger generation. From babies to teenagers, it’s possible that they can have juvenile arthritis. Knowing how to spot it means that measures can be taken to allow your child to live a full and normal life. Here, rheumatologist Dr Joel David explains the types, symptoms, diagnosis and treatment of juvenile arthritis.

What is juvenile arthritis and how common is it?

Juvenile idiopathic arthritis (JIA) is a term used to describe various conditions of inflammation (pain and swelling) of one or more joints that occur in children and teens under 16 years old. The term idiopathic means that the exact cause is unknown.

In order for a JIA to be diagnosed

• The inflammation needs to be present for at least 6 weeks
• Infection needs to have been excluded as a potential cause of the inflammation

JIA is most common in pre-school age children and is slightly more common in girls. It can also be present from as early as 9 months of age up to 16 years.

There are a number of different types of JIA - the number of joints affected and the distribution of joints determines the type. Knowing the type of JIA is helpful in planning treatment and predicting the future outcome.

What are the types of Juvenile arthritis?

1. Oligoarthritis

Oligoarthritis is the most common type of JIA. It often affects the knees (one or both) and/or ankles. With this condition, no more than 4 joints in total are affected. It has a good outcome and, with effective treatment, may not leave any long-term damage.

It’s important that the child has regular eye checks as inflammation of the front part of the eye is common and should be screened for specifically, or else it may go completely unnoticed.

2. Polyarticular

When more than 4 joints are affected, it’s classed as polyarticular JIA. This can develop suddenly or evolve from oligoarthritis. When this occurs in teenagers, especially girls, it may resemble adult-type rheumatoid arthritis and can progress into adult life. The joints that are usually affected include the hands (fingers and wrists), neck, shoulders, hips, knees, feet and even the jaw. The child may feel tired and unwell in addition to the pain and joint swelling, and could also have a low-grade fever.

3. Enthesitis-related

Entheses are the places where tendons and ligaments join onto the bone, the most common are:

• The Achilles tendon behind the ankle
• The sole of the foot
• Around the knee
• The hip joint
• The elbows

Enthesitis-related arthritis is more common in boys and has the potential to affect the spine. This leads to ankylosing spondylitis (AS), a chronic pain in the spinal joints, and also affects the eye, causing it to be painful and red.

4. Psoriasis related

Psoriasis related arthritis occurs along with the psoriasis skin rash (or nail changes). It can occur in patients when there is a family history of psoriasis.

This joint disease could look similar to polyarticular or oligoarticular arthritis. Often though, when the fingers and toes are affected, the whole digit is swollen (dactylitis). Eye inflammation (uveititis) can occur and can be severe and so, as with other types of JIA, screening is important for the eyes.

About 30-40% of children with this type of arthritis will develop adult arthritis.

5. Systemic arthritis

Systemic arthritis is often the worst type – and the rarest. The child can become very ill with temperatures, rashes, joint pain and swelling. Sometimes, there may be inflammation of the skin, the pleura (a lining around the lungs), the thin lining around the heart (pericarditis) and in rare cases, a massive systemic inflammation (macrophage activation syndrome).

Tips for Parents – What are the symptoms of JIA?

If your child has any of these symptoms for more than a couple of weeks, you should see a doctor:

• Painful, swollen or stiff joint(s)
• Joint(s) that are warm to touch
• A fever that keeps returning
• A limp but no injury

How is juvenile arthritis diagnosed?

There isn’t a specific test for JIA, but the doctor will take blood tests and x-rays. They may also do other tests, including:

• An ultrasound or MRI scan to try to see if arthritis is present and to rule out other conditions
• Removing fluid from a joint (aspiration) to rule out joint infection

What treatment is available for juvenile arthritis?

Joint injections with steroids, while the child is under local anaesthetic, can be extremely helpful. If the child is very young, this may need to be performed under general anaesthetic. However, usually if the child is over seven years of age, they tolerate the procedure very well.

If many joints are affected, disease-modifying antirheumatic drugs ( DMARD) will be required, such as methotrexate. This is given either as a tablet or via a weekly injection.

Occasionally, steroid treatment is needed. If the arthritis persists despite the treatment being maximised, then biological drugs are used (e.g. etanercept or adalimumab) and these are very effective.

All of these treatments need monitoring under the care of a specialist. Regular blood tests and in some cases regular ultrasound scans are required often.

Can a child live a full and active life like their peers?

Treatments these days are very effective. As a result, the long-term severe joint damage that used to be commonplace in JIA is no longer seen.

It’s highly likely that the child will be able to participate fully in both school and physical activity, despite having JIA. Therefore, it’s important that the child’s school knows about the condition so that they can facilitate the process of helping the child to lead a full and normal life.

Dr Joel David is a highly experienced rheumatologist who specialises in juvenile arthritis along with adult conditions such as rheumatoid and psoriatic arthritis. If you’d like to talk to him about joint issues concerning yourself or your child, don’t hesitate to book an appointment by visiting his profile.