There are several different forms of JIA, but the most common are oligoarticular arthritis, which affects up to four joints in the body, and polyarticular, which affects more than four joints, says Anjali Sura, MD, an assistant professor of pediatrics at SUNY Upstate University Hospital in Syracuse, New York. There is overlap among the types of JIA, along with multiple subtypes, and lots of debate about new classifications, says Jay Mehta, MD, an associate professor of clinical pediatrics at the University of Pennsylvania Perelman School of Medicine and the fellowship director at Children’s Hospital of Philadelphia.
Currently, other types of JIA include:
There’s no solid answer right now about why JIA develops, experts say. Some families develop a collection of autoimmune conditions, though not usually the same ones, and JIA can be one of those diagnoses, says Dr. Sura. Other families have no history of any autoimmune disease when it is diagnosed.
Some believe JIA happens as a combination of genetics and some environmental triggers, says Dr. Mehta, “but we don’t know what they are. There are some genes that are identified as having a potential role, but not everyone with those genes gets arthritis, and not all with arthritis have those genes.”
JIA is diagnosed typically with magnetic resonance imaging (MRI) or ultrasound imaging, as well as testing for other diagnoses, such as Lyme disease, to rule out other causes as well as other forms of arthritis. Effective treatment depends on an accurate diagnosis.
With the availability of JIA medications known as biologics, the prognosis for people living with the condition is excellent, says Sura. With the right treatment, people with JIA can expect to have a full quality of life and maintain a full range of joint motion. Before these drugs became available in the early 2000s, people with JIA could experience permanent disability and/or needed joint replacement surgery.
Medication to treat JIA can have side effects, so ongoing blood work may be needed to ensure, for example, that liver function remains healthy. Most drugs to treat JIA are immunosuppressive, says Sura, so infection risk can be higher than someone not taking these drugs. “I haven’t seen any serious infections among my patients, but they may have a cold that lasts one day longer,” she says. “And with the pandemic and the registry of JIA patients being followed, they don’t seem to have worse rates of COVID or more severe cases of it.”
While some kids who are diagnosed with JIA grow out of it, others go into remission, where symptoms go away for a long period of time, while some live with ongoing issues such as rashes, fever, slow growth, osteoporosis, and worsening arthritis. Rarely, JIA can affect the organs and cause issues with the endocrine system, kidneys, or heart.
It depends on the type and age of person when diagnosed with JIA, but “in general, about one-third of all kids outgrow it, one-third go into remission for a few years, and one-third have the more chronic form where they flare and still have juvenile arthritis into adulthood,” says Sura.
With mild JIA symptoms, pain relievers and/or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are used to help patients feel better physically. Sura says that in about 30 to 40 percent of her patients, this treatment is sufficient. However, these drugs don’t treat underlying joint damage if it exists.
“What I tell families is that they are welcome to try diet interventions, but there are no randomized control studies for juvenile idiopathic arthritis,” says Mehta. “If something works, I’m super happy for them, but it has to be a complement to the standard-of-care medicines.” In other words, such therapies help when they supplement — but never replace — drug treatment.
With the appropriate medication and other treatment, JIA can be well managed. When it is not, joint damage can occur. This can look like:
As an autoimmune condition, JIA occurs when the body wrongly attacks a normal part of itself thinking it’s being threatened. Similarly, people with JIA can experience other autoimmune conditions. They include:
The Arthritis Foundation
This website offers good information about juvenile idiopathic arthritis and how parents can talk to their children about it. The Arthritis Foundation also offers information about attending school and college with JIA and hosts summer camps and support groups around the United States and virtually where kids with juvenile arthritis can meet and interact with peers. They also feature a one-on-one helpline (online or phone) staffed by a licensed, clinical social worker who can offer support.
Taking Charge: Managing JIA Online
Aimed at teens who need to take more responsibility for their juvenile idiopathic arthritis as they grow up, this site — part of AboutKidsHealth and backed with medical guidance by Toronto’s The Hospital for Sick Children — gives a full look at what JIA is, what is needed to stay healthy while living with it, traditional and complementary forms of treatment, and other information for teens to take ownership of their condition as they head into adulthood.
American College of Rheumatology
While this a physician professional organization, it offers one-page information sheets about different arthritis medication and conditions that may be helpful for families of people with JIA.
Your Pediatric Rheumatologist
Speak with your child’s physician about what resources they’d recommend. “I think all of us really love what we do when we partner with families on this journey,” says Mehta. For his patients and their families, he says, “I’m with you and I will do my best to figure out what to do to get you answers.”
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