Juvenile Arthritis: More Than Growing Pains
Juvenile arthritis (JA), also known as juvenile idiopathic arthritis, is a chronic autoimmune disorder that affects children under the age of 16. It causes inflammation in the joints, leading to swelling, stiffness, and pain. While the exact cause is unknown, it is believed to be triggered by a combination of genetic and environmental factors. However, there is no evidence that foods, toxins, allergies or lack of vitamins cause the disease.
Types of Juvenile Arthritis (JA)
Juvenile arthritis is an umbrella term for different types of juvenile arthritis, each with its own set of symptoms and characteristics:
1. Oligoarticular JA: This is the most common type, affecting four or fewer joints, typically the knees, ankles, or wrists. It can also cause eye inflammation (iritis) in some cases.
2. Polyarticular JA: This type affects five or more joints, often symmetrically on both sides of the body. It can also cause fever, rash, and anemia.
3. Systemic JA: Also known as Still's disease, this type affects the entire body, causing fever, rash, and inflammation in various organs, in addition to joint pain.
4. Enthesitis-related JA. Children with his type have arthritis as well as enthesitis. This is a swelling of the tissue where bone meets a tendon or ligament. It often affects the hips, knees, and feet.
5. Psoriatic arthritis. This type has both arthritis and a red, scaly skin disease called psoriasis.
6. Undifferentiated arthritis. This type may have symptoms of two or more types of JA, or symptoms that don’t match any type of JA.
Symptoms of JA can vary in severity and may come and go in cycles.
Common symptoms include:
► Inflammation of joints: Joints may appear red and swollen and may feel still and painful to move. Pain may be especially noticeable upon waking or holding one position for a long period of time. The pain often causes a child to have difficulty walking, including a potential limp.
► Skin rash: A rash is typically one of the first signs of JA. It may appear spotty, pale red, or pinkish salmon-colored and may be accompanied by spikes in fever and may last a few minutes to a few hours. It commonly appears on the chest, upper arms and upper thighs, although it can be found on other parts of the body (but rarely the face).
► Eye issues: Eyes may appear red and feel dry and painful. Sensitivity to light and trouble focusing may also occur.
► Other symptoms: Extreme fatigue, loss of appetite, digestive issues (diarrhea and/or bloating), intermittent fever
There is no single definitive test for JA, and diagnosis is based on a combination of clinical findings, test results—including imaging and blood work, and the exclusion of other possible causes.
Early and accurate diagnosis is crucial for initiating appropriate treatment and managing the condition effectively.
Treatment often includes:
► Medications: to reduce pain and inflammation
► Physical and Occupational Therapy: to improve joint function, strength, and flexibility, and assist with daily activities
► Exercise and Weight Management: to maintain a healthy weight, reduce strain on joints, and manage symptom
► Complementary Therapies: Techniques like heat/cold therapy, massage, acupuncture, and mind-body practices may be recommend for pain relief and to help with stress management
Your doctor may also recommend regular eye exams, which can detect eye inflammation early.
In addition to medical treatment, it's essential to provide emotional support and encourage children to participate in school, social, and physical activities as much as possible. Accommodations like assistive devices or special education plans may be necessary. With proper management, many children with juvenile arthritis can lead active, fulfilling lives.
As for the question that every parent asks: “Does juvenile arthritis ever go away?”
The answer is “sometimes.”
For some children, JA goes into remission only to come back months to years later. For others it can go into permanent remission. It is difficult to predict the course of JA, however, advances in the treatment and monitoring of JA have improved the overall prognosis for all children.
Jaclyn Lozier, MD, FAAP, is the Chair of Pediatrics, Southwestern Vermont Medical Center and the Medical Director, SVMC Pediatrics.
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