Juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, is the most common type of arthritis in children under the age of 16.
Juvenile idiopathic arthritis can cause persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, while others have symptoms for many years.
Some types of juvenile idiopathic arthritis can cause serious complications, such as growth problems, joint damage and eye inflammation. Treatment focuses on controlling pain and inflammation, improving function, and preventing damage.
The most common signs and symptoms of juvenile idiopathic arthritis are:
Juvenile idiopathic arthritis can affect one joint or many. There are several different subtypes of juvenile idiopathic arthritis, but the main ones are systemic, oligoarticular and polyarticular. Which type your child has depends on symptoms, the number of joints affected, and if a fever and rashes are prominent features.
Like other forms of arthritis, juvenile idiopathic arthritis is characterized by times when symptoms flare up and times when symptoms may be minimal.
Take your child to the doctor if he or she has joint pain, swelling or stiffness for more than a week — especially if he or she also has a fever.
Juvenile idiopathic arthritis occurs when the body's immune system attacks its own cells and tissues. It's not known why this happens, but both heredity and environment seem to play a role.
Some forms of juvenile idiopathic arthritis are more common in girls.
Several serious complications can result from juvenile idiopathic arthritis. But keeping a careful watch on your child's condition and seeking appropriate medical attention can greatly reduce the risk of these complications:
Eye problems. Some forms can cause eye inflammation. If this condition is left untreated, it may result in cataracts, glaucoma and even blindness.
Eye inflammation frequently occurs without symptoms, so it's important for children with this condition to be examined regularly by an ophthalmologist.
Diagnosis of juvenile idiopathic arthritis can be difficult because joint pain can be caused by many different types of problems. No single test can confirm a diagnosis, but tests can help rule out some other conditions that produce similar signs and symptoms.
Some of the most common blood tests for suspected cases include:
In many children with juvenile idiopathic arthritis, no significant abnormality will be found in these blood tests.
X-rays or magnetic resonance imaging may be taken to exclude other conditions, such as fractures, tumors, infection or congenital defects.
Imaging may also be used from time to time after the diagnosis to monitor bone development and to detect joint damage.
Treatment for juvenile idiopathic arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.
The medications used to help children with juvenile idiopathic arthritis are chosen to decrease pain, improve function and minimize potential joint damage.
Typical medications include:
Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling or if there is a high risk of damage in the future.
DMARDs may be taken in combination with NSAIDs and are used to slow the progress of juvenile idiopathic arthritis. The most commonly used DMARD for children is methotrexate (Trexall, Xatmep, others). Side effects of methotrexate may include nausea, low blood counts, liver problems and a mild increased risk of infection.
Biologic agents. Also known as biologic response modifiers, this newer class of drugs includes tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi) and infliximab (Remicade, Inflectra, others). These medications can help reduce systemic inflammation and prevent joint damage. They may be used with DMARDs and other medications.
Other biologic agents work to suppress the immune system in slightly different ways, including abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret) and tocilizumab (Actemra). All biologics can increase the risk of infection.
Corticosteroids. Medications such as prednisone may be used to control symptoms until another medication takes effect. They are also used to treat inflammation when it is not in the joints, such as inflammation of the sac around the heart.
These drugs can interfere with normal growth and increase susceptibility to infection, so they generally should be used for the shortest possible duration.
Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone.
A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child.
A physical or occupational therapist may also recommend that your child make use of joint supports or splints to help protect joints and keep them in a good functional position.
In very severe cases, surgery may be needed to improve joint function.
Caregivers can help children learn self-care techniques that help limit the effects of juvenile idiopathic arthritis. Techniques include:
Eating well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help maintain an appropriate body weight.
Adequate calcium in the diet is important because children with juvenile idiopathic arthritis are at risk of developing weak bones due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.
Family members can play critical roles in helping children cope with their condition. As a parent, you may want to try the following:
If your pediatrician or family doctor suspects that your child has juvenile idiopathic arthritis, he or she may refer you to a doctor who specializes in arthritis (rheumatologist) to confirm the diagnosis and explore treatment.
Before the appointment, you might want to write a list that includes:
Your doctor may ask some of the following questions:
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