Juvenile Arthritis: Effects of Diagnosis and Coping
Medically reviewed by David Ozeri, MD
Juvenile arthritis (JA) is an umbrella term describing arthritis conditions that affect children under 16. According to the Arthritis Foundation, JA affects nearly 300,000 children in the United States.
Most types of JA are autoimmune diseases where the immune system malfunctions and attacks healthy tissues. JA is also known as childhood arthritis, juvenile idiopathic arthritis (JIA), and juvenile rheumatoid arthritis (JRA).
The exact causes of JA are unknown, but researchers suspect certain genes and environmental triggers are involved. Most children diagnosed with JA are ages 2 to 5. But children as young as 18 months and as old as 16 years can also develop the condition.
This article will cover juvenile arthritis characteristics, symptoms, treatment, and more.
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Characteristics of Juvenile Arthritis
Juvenile arthritis can lead to permanent joint damage. That means it can affect your child's ability to walk, play, and care for themselves. It can also result in disability.
There is no cure for JA, but many children can achieve remission, when the disease is not active. Any joint damage will remain but can be treated with surgery if such damage affects function and mobility.
For a long time, it was believed that children would outgrow juvenile arthritis. However, it is now known that JA will continue to be active and worsen without aggressive treatment.
Autoimmune Types
The most common type of JA is believed to be an autoimmune disease, a condition in which the body's immune system often malfunctions and attacks healthy tissues. In autoimmune JA, the synovial linings of joints are attacked, leading to inflammation, pain, stiffness, and tenderness.
What Is Inflammation?
Inflammation is the body's defense against injury, illness, or infection. Signs of inflammation include pain, heat, redness, swelling, and loss of function, although it is possible to experience inflammation without symptoms.
Inflammation is either acute (short term) or chronic (long term). Acute inflammation helps the body repair itself. In contrast, chronic inflammation is harmful to your health.
Inflammation with autoimmune JA can lead to bone erosion and cartilage damage. Bone damage from JA affects bone growth, leading to bones growing at different rates or in abnormal shapes or sizes.
Autoimmune JA falls into different subcategories, including:
Systemic arthritis: This type of JA causes a systemic (whole-body) response, which includes fevers, skin rash, joint inflammation, and inflammation that affects body organs. Systemic arthritis may continue into adulthood.
Polyarthritis: This JA type affects five or more joints, typically the small joints of the fingers and toes. It will also cause low-grade fever, fatigue, and rheumatoid nodules (small bumps under the skin near affected joints). It is a symmetrical arthritis, meaning it can affect the same joints on both sides of the body. It is more common in people assigned female at birth and may be the most severe of all JA types. It tends to present like adult rheumatoid arthritis and often continues into adulthood.
Oligoarthritis: This type of JA affects less than five joints, mainly the large joints, such as the knees or ankles. It is an asymmetric arthritis, meaning it affects joints on one side of the body but not necessarily those on both sides. Oligoarthritis can also cause eye inflammation. Up to 50% of children with JIA will have this type, and children assigned female at birth who are under the age of 8 are most likely to have it. Many children with this type of JIA will have improvements over time.
Juvenile psoriatic arthritis (juvenile PsA): Juvenile PsA affects children with the autoimmune skin disease psoriasis or who have a parent or sibling with psoriasis. It causes joint pain and inflammation and a scaly rash that can appear anywhere on the body.
Enthesitis-related arthritis: Also called juvenile spondyloarthritis, this JA type causes inflammation of the spine, sacroiliac joints (the joints located between the sacrum and the ilium bones of the pelvis), and entheses (the places where tendons attach to bones and joints). Eye inflammation can also occur with this JA type.
Undifferentiated arthritis: This diagnosis is given to children with arthritis who do not fit any of the above types or have symptoms of multiple types.
Pediatric Osteoarthritis
Pediatric osteoarthritis (OA) is a type of JA that is not autoimmune. OA primarily affects adults but can lead to joint pain and stiffness of growing bones and joints in children. Pediatric OA is sometimes called early-onset osteoarthritis.
This type of childhood OA can be a congenital (present at birth) condition that weakens bones, a genetic condition that affects bone and tissue growth like dwarfism, or the result of a traumatic injury like a car accident. It can also occur in children who are severely overweight or who have autoimmune JA.
Causes of Juvenile Arthritis
JA typically occurs when the immune system attacks the body's own healthy cells and tissues. It is unknown exactly why this happens, but researchers suspect genetics and a person's environment play a part.
This means that JA can run in families but can also be triggered by exposure to triggers like an infection or illness, chemicals or toxins (i.e., pollutants and secondhand smoke), dietary factors, sun exposure and vitamin D, and physical and emotional stressors.
Does Juvenile Arthritis Ever Go Away?
JIA is a chronic disease, which means it can last for months or years. For some people, treatment helps JIA go into remission. Remission may last months or years or over an entire lifetime. Research shows that many children with JIA can enter remission with little or no permanent damage.
Early Symptoms of Juvenile Arthritis
It may take years for a child to receive an appropriate JA diagnosis. But JA has some common early symptoms you may want to look for.
Early symptoms of JA can include:
Joint pain and swelling
Joint stiffness in the morning
High fevers
Appetite loss
Anemia results from a lack of healthy red blood cells or hemoglobin (a protein found in red blood cells) to carry oxygen to tissues throughout the body. Symptoms of anemia include tiredness, weakness, shortness of breath, irregular heartbeat, and pale skin.
If your child is experiencing joint pain and stiffness in the morning along with any of the above systemic symptoms, you should contact their healthcare provider as soon as possible.
Progressive Symptoms and Steps to Diagnosis
JA is a progressive condition that can become severely worse without treatment. Even so, it is possible to experience remission with early diagnosis and treatment. Some research suggests that progression can be halted to where a child does not experience symptoms, which may extend even into adulthood.
Disease progression will vary from person to person. It may also depend on how advanced the disease was at diagnosis and when treatment started.
Symptoms that indicate disease progression of JA include:
Difficulty with everyday tasks
Digestive troubles due to inflammation of the digestive system
Spinal inflammation, especially in the cervical spine (neck)
Bone and cartilage damage
Growth problems due to joint and bone damage
Lung disease
Heart damage
Vision problems
Late-onset puberty
Some children may not experience remission. For them, JA symptoms and progression may continue into adulthood, requiring lifelong treatment and continuous reassessment. Even in these cases, autoimmune arthritis is treatable and manageable, and complications and severe symptoms can be prevented.
Diagnosing Juvenile Arthritis
Your child's healthcare provider will start with a complete medical history and physical examination to diagnose JA.
For medical history, the healthcare provider will want to know:
When joint pain and swelling start
Whether symptoms have gotten worse over time
Whether the child has stiffness after periods of inactivity, such as when waking up in the morning
Any other possible causes of symptoms, including an injury, illness, or family history of autoimmune diseases
The healthcare provider will also examine your child's joints. With the physical exam, they are looking for swelling, warmth, decreased range of motion, and muscle loss near affected joints.
Lab work, including blood, joint fluid, and tissue tests, will also be requested to rule out other possible causes. These tests might also help classify what type of JA your child has.
Different types of imaging might also be requested to aid in diagnosis. This might include conventional X-rays, magnetic resonance imaging (MRI), ultrasound, and bone scans.
What Else Could Joint Symptoms Be?
Many conditions can mimic JA due to the symptoms they share. This includes bone and joint infections, muscle and bone diseases, and less common rheumatic diseases. A complete evaluation can help your child's healthcare provider determine and confirm a diagnosis.
Creating a Treatment Plan for Juvenile Arthritis
If your child's healthcare provider suspects or confirms a diagnosis of JA, they will refer you to a pediatric rheumatologist. A pediatric rheumatologist is a medical doctor (M.D.) specializing in diagnosing and treating arthritis conditions in children.
Goals for treating JA include:
Control disease symptoms, including inflammation and pain
Prevent structural damage
Avoid disease complications and drug toxicities
Preserve normal joint growth and function
Optimize quality of life and social participation
Typical medications used in the treatment of JA include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like Advil (ibuprofen) and Aleve (naproxen sodium) can reduce pain and swelling.
Conventional disease-modifying antirheumatic drugs (DMARDs): These are given when NSAIDs are not enough to relieve symptoms and there is a concern joint damage might occur. Methotrexate is the most commonly prescribed conventional DMARD.
Biologic DMARDs: These medications reduce systemic inflammation and prevent joint damage by suppressing the overactive immune system. They are typically prescribed with conventional DMARDs and other medicines.
Corticosteroids: These medications can help control inflammation and disease symptoms until DMARDs take effect. Because corticosteroids can interfere with growth and increase the risk of severe infections, they are only prescribed for short periods.
Oral and topical NSAIDs are commonly used to treat pediatric OA. Autoimmune types typically need more aggressive treatment, including DMARDs and corticosteroids.
Your child's healthcare provider may recommend your child work with a physical therapist to keep joints flexible and in motion and to maintain muscle strength around joints. They may also recommend occupational therapy. An occupational therapist can suggest support tools (i.e., splints and braces) to protect joints and keep them functional.
If joints have become damaged or no longer function, surgery may be recommended to fix and replace affected joint and bone areas. Fortunately, because of the many available treatment options, most children will never need surgery to manage JA, even in their adult years.
Related: Arthritis Surgery: Options, Pros vs. Cons, Surgeons
Self-Care for Children With Juvenile Arthritis
Parents and caregivers can help children learn self-care techniques to limit the effects of JA.
The Arthritis Foundation recommends the following self-care tips:
Exercise: Regular exercise is crucial in managing JA because it promotes muscle strength and joint flexibility. Walking, swimming, and low-impact exercises promote joint health without injuring joints. These activities can also relieve pain and improve mood and sleep.
Rest: If your child's joints are inflamed and sore, remind them to take breaks. Alternating between rest and activity reduces pressure on joints and prevents injury.
Heat and cold therapy: Some children can benefit from heat and cold for managing joint pain and stiffness. An ice pack can take down swelling and reduce pain, while a warm shower or heating pad can relieve stiff joints and tight muscles.
A healthy diet: Some people with JA lose weight because of poor appetite, while others gain weight from inactivity and medications used to treat the condition. Encourage your child to eat a balanced diet of fruits and vegetables, lean proteins, whole grains, and low-fat dairy while limiting junk foods and processed foods. Getting plenty of calcium and vitamin D is essential since JA increases the risk for weak bones because of decreased activity and corticosteroid use.
Treating JA Flare-Ups
Juvenile arthritis can be unpredictable, and most children with the condition experience periods called flare-ups in which disease symptoms get worse for short periods.
Most flares cause pain and swelling of joints. Additional symptoms of JA flares include:
Flu-like symptoms, including fever and nausea
Extreme fatigue
Skin rash
Eye inflammation
Depressed mood
Most flare-ups can be managed at home with rest and self-care. If flare symptoms last more than a few days or worsen, contact your child's healthcare provider. They can prescribe a corticosteroid to help manage inflammation and pain or other treatments to help shorten recovery time.
Support and Resources
Your child's healthcare team can be a helpful resource. They can offer referrals to social workers and therapists. They can also give you information about pain management, nutrition, medication management, balancing school and treatment, and more.
It is also helpful to work with your child's school and request any accommodations your child might need, including a plan for what to do when symptoms flare or when your child has medical appointments. The school should also be aware if your child needs additional time or assistance going from one classroom to another or needs treatment at school.
Living with JA can be stressful for your child. Encourage them to speak up if they are having difficulty coping with the effects of the condition or with their emotions. It might be helpful for your child to talk to a mental health professional or join a support group for children and families managing the effects of JA.
Summary
Many types of juvenile arthritis are autoimmune arthritis, where the immune system malfunctions and attacks the joints and other healthy tissues. The exact cause of JA is unknown, but researchers believe genetics and environmental factors contribute to its development.
Pediatric OA is a rare type of non-autoimmune arthritis affecting children. It can be congenital and caused by genetics, another autoimmune disease, an injury, or being severely overweight.
The earliest symptoms of JA are joint pain and stiffness, and systemic symptoms like fatigue and fever. JA is considered a progressive condition that gets worse over time. However, many different treatment options are available to slow down the disease's effects and may even lead to remission.
For some young people, JA may progress and become adult arthritis. Even in these situations, the disease can still be managed, and joint damage and disability are preventable. If your child is experiencing signs of JA, contact their healthcare provider immediately.
Having a normal and active life with JA is possible. Support groups are a helpful option for children with JA to interact with other children struggling similarly. It is also crucial to help your child manage their feelings about JA and to encourage them to speak up if they are struggling to cope or feel depressed.
Read the original article on Verywell Health.
