What is juvenile idiopathic arthritis?
Juvenile idiopathic arthritis (JIA) is inflammation (swelling) of one or more of your joints. It first occurs before your 16th birthday.
JIA is slightly more common in girls. It most commonly occurs in pre-school age children or teenagers.
There are different types of JIA and symptoms vary between the different types. Knowing which type you have helps assess the likelihood you'll grow out of JIA.
JIA may be difficult to control in some people, but most cases will be well controlled with treatment most of the time. If you have arthritis as part of another condition, it's often managed in a very similar way to JIA.
What should I look out for?
If you have 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
- increased tiredness
- a fever that keeps returning
- a limp but no injury.
If you think that you or someone you know may have JIA, book a GP appointment as soon as possible. Tell them your symptoms and concerns. They'll consider referring you to a paediatric rheumatology consultant.
We don't completely understand what causes JIA. In fact, that's what ‘idiopathic’ means.
What we do know is that JIA is an autoimmune disease. Your immune system is your body’s way of defending itself against injury, illness or bacteria.
Your body can defend itself by causing inflammation or swelling. But when you have JIA, your body creates inflammation in a joint or joints when it doesn’t need to. This inflammation then causes stiffness and pain.
Is JIA genetic?
It's very rare to have two people in the same family with JIA, but we do know that genetic factors are involved. This is to do with the genes that are passed down from your parents.
JIA is thought to be due to a combination of genetic factors and trigger factors from the environment, for example the infections that your immune system has been in touch with.
There’s no evidence that a specific infection causes JIA, but an infection may trigger your immune system's response that then carries on and affects your joints.
Different types of JIA
There are several different types of juvenile idiopathic arthritis (JIA), some of which are milder than others.
You need to know which type you have because this will help your doctor plan your treatment and give you advice.
|Type of JIA||What is it?||What are the symptoms?||How will it affect me?||What else should I know?|
|Oligoarthritis||The most common type – affects about two thirds of young people with arthritis. It's often mild.||Most commonly affects one or both knees.
Most likely type to cause eye inflammation (chronic anterior uveitis) – you'll need regular eye checks.
|Most likely type to go away leaving little or no joint damage.||If you develop problems with five or more joints after six months, this is called extended oligoarthritis. This can cause joint damage. Your doctor may suggest early treatment with drugs like methotrexate to keep the damage to a minimum.|
|Polyarthritis||The second most common type of JIA.
It may come on suddenly or can steadlily involve more joints over a period of months.
|Painful swelling in fingers, toes, wrists, ankles, hips, knees, the neck and jaw.
You may feel unwell and tired and occasionally develop a slight fever.
|Symptoms may continue into adult life, but it can go into remission, where all the symptoms disappear.||A blood test will show whether a marker called rheumatoid factor is present in your blood.|
|Enthesitis-related JIA||Affects the places where the tendons attach to the bone (entheses), causing inflammation.||Often affects the joints of the leg and spine.
Associated with a red painful eye condition (acute uveitis).
|You may develop stiffness in your neck and lower back in your teens.||There may be a family history of ankylosing spondylitis or inflammatory bowel disease because of a particular genetic marker called HLA-B27.|
|Psoriatic arthritis||Psoriasis is a skin rash. A combination of joint pain and the rash is known as psoriatic arthritis.||Usually affects fingers and toes but may affect other joints too.
Joints may be affected before the psoriasis appears – your doctor may look closely at fingernails and toenails for early signs.
Uveitis is fairly common but it's the painless type that doesn't look red.
|It’s difficult to predict, but between 30-40% have ongoing disease into adulthood.||Your doctor may ask if anyone else in your family has the condition.|
|Systemic-onset JIA||Your doctor may ask if anyone else in your family has the condition.||Enlarged glands in your neck, under your arms and around your groin.
Your doctor may find your spleen and liver are enlarged, and, very occassionally, the covering of your heart is inflamed (pericarditis).
In the first few weeks there may be no sign of swollen joints, and the diagnosis may be uncertain.
|It can be difficult to predict how it'll affect you but usually the fever and rash will settle, although the arthritis may continue for several years before settling.||Lots of tests may be needed to confirm the diagnosis and this can be a worrying time.|
How will JIA affect me?
Many children who have JIA won't have any symptoms when they're adults, but it’s not possible to accurately predict this. In most cases, childhood arthritis has a good outcome. You should look forward to a future that’s no different from those of your friends and classmates.
In at least 30% of cases, however, arthritis can remain active into adult life. Some young adults with JIA have joint damage that limits their daily activities to some extent and a few may need joint replacements. Other problems can sometimes occur. Some people are physically smaller than average or have osteoporosis as a result of their arthritis and/or treatment with steroids.
A successful outcome in JIA requires many things, including:
- a positive approach
- an experienced team working alongside your GP
- a caring, helpful environment with support from family, friends and teachers.
You also need to know how to get help that you can understand, know who to approach and be confident enough to ask for support and advice.
To make a diagnosis, a paediatric (young person's) rheumatologist will examine you and ask you questions. This will probably be done in a hospital.
There isn't a specific test for JIA, but your doctor will take blood tests and x-rays. They may also do other tests, including:
- ultrasound or MRI scans to try to see if there's arthritis and to rule out other conditions
- removing fluid from a joint (aspiration) to rule out joint infection
- bone marrow examination to rule out some rare conditions, especially if they think you have systemic-onset JIA.
You'll be diagnosed with JIA if:
- you've had arthritis for six weeks or more
- your symptoms started before your 16th birthday
- your doctor has ruled out other conditions that can cause arthritis.
The aim of treatment for juvenile idiopathic arthritis (JIA) is to:
- control the symptoms of arthritis
- enable you to lead an active life at school or college
- enable you to enjoy an active family and social life
- help you become an independent adult.
It’s important to do all of these things but at the same time try to reduce any side-effects caused by the medicines.
Drugs for JIA
Drugs can’t cure arthritis, but they can control the symptoms and help to reduce the possibility of joint damage. An increasing number of medicines are now available.
These drugs help to control the pain of arthritis.
- Common painkillers include paracetamol, codeine or combinations e.g. co-codamol.
- They have to be taken regularly for maximum effect, which lasts hours not days.
- Side-effects include constipation, drowsiness and feeling a bit spaced-out.
Read about painkillers.
Physiotherapy and occupational therapy for JIA
- help your arthritis
- relieve pain
- improve your ability to get on with life
- provide exercises to stretch soft tissues and build up muscles
- improve your heart and lung fitness.
Your physiotherapist and occupational therapist will assess you and will develop a programme for your individual needs so that you’re able to do the activities you want and need to be able to do in your daily life. They may give you exercises and coping strategies and sometimes they may provide equipment to make daily activities easier.
Physiotherapists will help you with daily exercise by giving you a plan to follow that suits your needs. Your exercise plan will aim to make your muscles stronger and more flexible, which may help prevent damage to your joints and improve your movement. If you have a flare-up or a specific joint problem your physiotherapist will help you to improve or regain your strength.
Your therapists can provide equipment to help with your daily routine of washing and getting ready. An occupational therapist can give advice and provide equipment to help you be independent – for example, an aid to get in and out of the bath, if necessary.
Managing your symptoms
The first thing you can do to help yourself is to find out as much as you can about your condition so that you know what to expect and how it could affect you in the future.
Another really important thing you can do to help yourself is to improve your general health. You can do this by:
- eating healthily
- getting lots of exercise
- getting enough sleep
- not smoking
- avoiding illegal drugs and too much alcohol.
Exercise is important for general fitness, protects against osteoporosis and helps you to relax. Weight-bearing exercise (such as walking) will help prevent osteoporosis and keep you fit. Try to set aside 15–20 minutes each day to work out. This doesn’t need to be too energetic but you should check that each joint in your neck, spine, arms and legs moves fully. As your arthritis becomes controlled and your general fitness improves you can make the exercises a bit harder.
Your diet is very important when you’re growing up as it keeps you healthy and makes your bones strong. It’s important to take steps when you’re young to help prevent osteoporosis in the future. Eating plenty of dairy products (for example milk, cheese and yoghurt) will help. Generally speaking, you should aim for a well-balanced diet with plenty of fruit and vegetables and a high fibre content, avoiding too much fat.
The effects of JIA
JIA can have different effects on your body, though your symptoms may vary from day to day.
Flare-ups of JIA (where symptoms get worse) can happen after:
- periods of stress
- changes in medication.
But they can often happen for no apparent reason.
- reduce your appetite
- reduce energy levels
- cause joint pain, swelling and stiffness.
Sometimes you'll be able to manage the symptoms with an non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen for a few days or weeks. But if your symptoms are troubling you or they carry on you should contact your rheumatology team.
Your joints may feel stiffer after resting, for example first thing in the morning.
To help with stiffness. you should do some gentle activity. Swimming can be very good, especially in a warm pool. You might need to adapt this if you're having a flare-up.
JIA can affect sleep patterns. You may also feel fed up as a consequence of joint pains, frustrated at not being able to do everything you want to, or due to difficulties with medication. It's very important to share these concerns with the paediatric/adolescent rheumatology team.
Between 10 and 20% of people with JIA will develop a potentially serious inflammatory eye condition called uveitis.
As many as half of young people who develop uveitis could develop complications, such as cataracts or glaucoma, or need eye surgery. If it's left untreated, uveitis can potentially lead to sight loss.
Uveitis can cause pain and redness in the eyes, but it can also develop without any noticeable symptoms. The type most associated with JIA, chronic anterior uveitis, doesn't cause any pain or redness.
It's important to be screened by an eye specialist (ophthalmologist) so that it doesn't go undetected. They'll check your sight and then carry out an exam with a bright light. The exam is painless.
The treatment for uveitis is initially steroid drops. Drugs called methotrexate, tocilizumab and adalimumab can also be prescribed. Versus Arthritis is funding studies which are looking at the effectiveness of these drugs in treating uveitis.
JIA probably won't affect puberty, but sometimes arthritis or some medications (for example steroids) can make the changes of puberty happen later.
In girls, periods can become irregular if arthritis is very active. Some of the medications, such as methotrexate, can have the same effect.
If you're worried about how you look or about changes happening to your body, discussing this with your family, friends, your school nurse or rheumatology team can be helpful.
JIA probably won’t affect your growth, but sometimes having severe arthritis and/or being on steroid tablets can slow growth. If your growth is slower than normal for a time, it can often catch up later, especially when arthritis is well controlled.
If active arthritis is left untreated in a joint, the growth of that joint can be affected. It’s important to get control of the arthritis before that happens.
You may have trouble with your teeth if you have difficulty brushing, but also because of effects of medications. It's important to have regular dental check-ups. You may need orthodontic advice if arthritis has affected your jaw.
You might find that an electric toothbrush is helpful. They can do some of the work for you to help make sure you clean your teeth thoroughly.
If possible, ask for sugar-free drugs. If you take medications by mouth, brushing your teeth after is a good idea.