what is juvenile idiopathic arthritis (JIA)?

• Juvenile – symptoms start before 16-years-old.

• Idiopathic – Idiopathic means the cause is unknown. Genetic, hormonal, environmental and infectious factors may be involved, although no clear trigger has been identified.

• Arthritis – inflammation of joint which can cause swelling, pain, and limitation of motion.

Juvenile idiopathic arthritis (JIA) is the most common form of arthritis in children and adolescents. JIA was formerly known as juvenile rheumatoid arthritis (JRA), but the name was changed because it is different from adult rheumatoid arthritis (RA).

how is JIA diagnosed?

For a child to have juvenile arthritis, symptoms must start before the age of 16. Joint swelling, limited motion, or other changes in the joint with arthritis must be present continuously for at least six weeks. Labs and imaging (X-rays, ultrasound, MRI) are often needed to make sure the child doesn’t have some other cause of joint pain and swelling. Diagnosis is made by history and physical exam. Lab test alone cannot be used to make a diagnosis.

how is JIA treated? 

The goals of treatment for JIA include: controlling inflammation, relief of pain and maintaining joint function. Reaching complete remission (no signs or symptoms of disease) on medication can be achieved by many children. Sometimes children will continue with low disease activity.

The American College of Rheumatology (ACR) recommends a medication step-up approach, using drugs with greater power once the previous treatment has failed. The starting point for treatment depends on the severity of the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed as first-line treatment of symptoms, followed by non-biologic disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. Low-dose oral steroids, if needed, may be used for short periods. Often it takes trying different medications to see what works best for each child. It can take time to find the right medication or combination of medications to best control a child’s JIA. Just like no two children are the same, what works for one child may not work for another. This can often be discouraging or overwhelming at times.

In cases of severe or persistent arthritis, biologic agents are recommended. In patients with systemic JIA or Ankylosing spondylitis, steroids or biologics are often needed sooner in the disease course than in children with other types of JIA. Biologic medications work by suppressing a portion of the immune system to control inflammation. As treatment is stepped up, the suppression of the immune system may be greater. Your provider will discuss in detail possible side effects of recommended medications.

Your provider will discuss things to consider when choosing what medication is best for your child, how soon, how long, how often, possible side effects, tolerance of route of administration, and other issues.