Juvenile Arthritis: The Big Disease In A Little Body
Medically reviewed by Carmen Fookes, BPharm. Last updated on July 1, 2021.
Juvenile Arthritis Is An Umbrella Term
Juvenile arthritis is not a single disease. Rather, it describes several autoimmune and inflammatory conditions that can develop in children under the age of 16, such as:
- Juvenile idiopathic arthritis (JIA)
- Juvenile dermatomyositis
- Juvenile lupus
- Juvenile scleroderma
- Kawasaki disease
- Mixed connective tissue disease
Juvenile arthritis affects nearly 300,000 children in the United States.
No Exact Cause Found For Most. Symptoms Vary Depending On Type.
For most forms of juvenile arthritis, no exact cause has been found. Research has not shown any link between toxins, foods, or allergies and the disease. Some research suggests that genes inherited from a child's parents may play a role, but more studies are needed.
Pain, joint swelling, redness and warmth are common symptoms; however, other symptoms vary depending on the type of juvenile arthritis. The next few slides give a brief overview of each different condition.
Juvenile Idiopathic Arthritis: A Term Within A Term
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA), is considered the most common form of juvenile arthritis. JIA includes six subtypes: oligoarthritis, polyarthritis, systemic, enthesitis-related, juvenile psoriatic arthritis and undifferentiated.
Like other forms of arthritis, symptoms arise because the immune system mistakenly attacks the body’s tissues, causing inflammation in the joints and potentially other areas of the body. The most common symptoms are joint pain and swelling, fever and rash. Limping, stiffness, excessive tiredness and sleep problems may also occur. Nobody knows what causes JIA but it is not contagious.
Juvenile dermatomyositis (JDM) usually strikes children between the ages of 5 and 10 and affects approximately three in every million children, or an estimated 3,000 to 5,000 children in the U.S.
Symptoms include muscle weakness and a red or purplish skin rash on the eyelids or cheeks. A patchy rash may also appear around the nails, elbows, knees, chest and back. One in five children may also experience joint symptoms, but these are generally mild. Running, climbing stairs, sitting from a lying position or standing from a seated position may become difficult.
Lupus is an autoimmune disease. In autoimmune diseases the immune system attacks the body for unknown reasons. Almost every organ in the body can be affected, including the skin, joints, kidneys, heart, lungs and central nervous system. When lupus occurs in children it is called juvenile lupus. Systemic lupus erythematosus (SLE) is the most common form.
Between 5,000 and 10,000 children have SLE in the United States. Girls are more frequently affected than boys.
Juvenile scleroderma describes a group of conditions in children that cause the skin to tighten or harden. In fact, scleroderma literally means “hard skin”.
Two different types exist. One mainly affects the skin and the other can affect the entire body as well. Juvenile scleroderma is a relatively rare disease but is more common in girls.
Kawasaki disease is a rare condition that usually strikes children under the age of five. It involves inflammation (redness, swelling) of the blood vessels, especially the arteries around the heart.
Symptoms are usually well-defined and include persistent high fever, bloodshot eyes, redness around the mouth, a body rash and redness and swelling of the feet and hands. Children of African and Asian ancestry are more likely to develop the disease, and the incidence is higher in boys than girls.
Typically only a few thousand cases of Kawasaki disease are diagnosed in the United States each year, but since the COVID-19 outbreak, the incidence of Kawasaki disease and a similar condition, called Multisystem Inflammatory Syndrome in Children (MIS-C) has increased about 13-fold. In approximately 92% of cases, the children have also tested positive for COVID-19.
Long-term heart conditions can result if the disease is not treated properly.
Mixed Connective Tissue Disease (MCTD)
Rather than being just one single condition, MCTD is a mixture of three different disorders: lupus, scleroderma and polymyositis (a condition marked by inflammation and breakdown of skeletal muscle tissue).
Early symptoms include tiredness; mild fever; cold, numb and swollen fingers (giving them a sausage-like appearance) and muscle and joint pain. Over time, the heart, lungs, kidney or other organs may become affected. MCTD is very rare and diagnosis may be difficult, because the symptoms of the three diseases usually occur one after another over a long period of time.
Fibromyalgia is commonly thought of as a condition that affects adults; however, juvenile onset fibromyalgia affects about 2% to 6% of school-aged children, most commonly teenage girls.
Fibromyalgia is characterized by widespread long-lasting pain, tender areas, tiredness, memory problems and mood changes. Fibromyalgia pain varies depending on the time of the day, activity level, weather, and degree of sleep deprivation. People with fibromyalgia are 10 times more likely to have restless legs syndrome and most also meet the criteria for a diagnosis of chronic fatigue syndrome as well.
Diagnosing Juvenile Arthritis
Because the term "juvenile arthritis" encompasses so many related, but different, disorders, obtaining an accurate diagnosis can be a long and detailed process.
There is no single blood test that confirms any type of juvenile arthritis. Your doctor will perform a careful physical exam, along with a thorough medical history. Specific laboratory tests may also be ordered depending on the type of juvenile arthritis suspected.
Treatment Of Juvenile Arthritis
Most treatment plans involve a combination of medication, physical activity, eye care and healthy eating. Treatment aims to reduce inflammation, control pain and just make life more bearable for the children affected.
Unfortunately, there is no cure, although remission (a period of time where symptoms of the disease are absent) can sometimes be achieved.
Medication Choice Depends On Type of Juvenile Arthritis
The most common classes and examples of medicines for juvenile arthritis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen
- Disease-modifying antirheumatic drugs (DMARDs): methotrexate and sulfasalazine (Azulfidine)
- Tumor necrosis factor (TNF) blockers: etanercept (Enbrel) and adalimumab (Humira)
- Immune system modifiers: abatacept (Orencia), anakinra (Kineret), rituximab (Rituxin), and tocilizumab (Actemra)
- Corticosteroids: prednisone.
Surgery may also be used later on in the disease to correct leg length discrepancy, straighten or replace a deformed or damaged joint.
Eye Care And Dental Care Important Too
The eyes are particularly affected in oligoarthritis, a form of juvenile idiopathic arthritis (JIA). Children should have their eyes checked by an eye specialist at diagnosis and then regularly thereafter to reduce the chance of vision loss.
JIA may also cause pain, stiffness and alter the growth of the jaw joint; which can make brushing and flossing difficult. Oral devices or rinses may be suggested to help teeth and gums stay healthy.
Splints help keep joints in the correct position and relieve pain and are commonly used for knees, wrists, and fingers.
Shoe inserts (called orthotics) can correct differences in leg length and improve balance problems.
Custom splints are usually made by an occupational or physical therapist.
Help Your Child Address Emotional And Social Effects Of The Disease
Dealing with juvenile arthritis can be hard for a child emotionally. Children with the condition are often teased and bullied, and many teachers don't believe in the accommodations a child with juvenile arthritis needs.
Some states offer a school awareness program and excellent advice is available on the Juvenile Arthritis section of the Arthritis Foundation website as well. Consider joining the Drugs.com JRA Support Group, too. The success of treatment depends on how well your child follows the treatment plan, so it is important they stay happy and healthy.
Finished: Juvenile Arthritis: The Big Disease In A Little Body
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