Juvenile Arthritis: Types and Management

Juvenile arthritis is a kind of arthritis that occurs in children below 16 years and involves swelling of the synovium (a tissue that lines the walls of the joints).

It is described as an auto-immune disease meaning that the body’s immune system attacks the body cells (healthy joint tissues) instead of foreign invaders such as virus and bacteria. This leads to joint damage.

Juvenile arthritis is also called Idiopathic juvenile arthritis (IJA). This means that the precise cause is not known. However various research has been able to link its occurrence to genetics, environment or certain infections.

Symptoms of Juvenile Arthritis

  • Joint stiffness, especially in the morning or after periods of inactivity
  • Pain, swelling, and tenderness in the joints.
  • Persistent fever
  • Rash
  • Weight loss
  • Fatigue
  • Irritability
  • Eye redness
  • Blurred vision

Types of Juvenile Arthritis

Systemic arthritis

This form  can affect the entire body or many systems of the body. It is also known as Still’s disease.

This type is usually associated with high fever and rash and can also affect internal organs but usually not the eyes. Boys and girls are equally affected.

Oligoarthritis

This affects fewer than five joints in the first six months that the child has the disease. The joints most commonly affected are the knee, ankle, and wrist.

It can affect the eye, most often the iris(uveitis). It is more common in girls than in boys, and many children will outgrow it when they become adults

Polyarthritis

It involves five or more joints in the first six months of the disease often the same joints on each side of the body(symmetrical).

This type affects the joints in the jaw and neck as well as those in the hands and feet. It is also more common in girls than in boys and more closely resembles the adult form of arthritis.

Psoriatic Arthritis

This is seen in children who have both arthritis and a fungal skin disorder called psoriasis.

The child might get either the psoriasis or the arthritis years before developing the other part of the disease. Children with this type of arthritis often have pitted fingernails.

Enthesitis-related arthritis

This type of arthritis often affects the spine, hips, eyes, and entheses (the places where tendons attach to bones). It occurs mainly in boys older than 8 years of age.

There is often a family history of arthritis of the back (called ankylosing spondylitis) among the child’s male relatives.

Diagnosis/Treatment

There is no single test to diagnose IJA. Instead a combination of tests are used.

Medical history is taken and symptoms such as swelling, stiffness and pain are inquired about.

Blood work for certain cell markers or possible infections and imaging to observe muscles and bones and bones are also necessary

The goals of treatment include

  • To relieve pain and reduce swelling
  • To increase joint mobility and strength
  • Prevent joint damage and other complications

IJA can be managed with medications, but other than drug treatment, patients are often advised to exercise regularly and maintain healthy weight, as the disease is triggered by inactivity.

Various medications are available for treatment and the physician prescribes based on the peculiarity of the patient’s symptoms and other factors.

They include:

  • NSAIDs (Non-steroidal anti-inflammatory drugs) which are painkillers such as ibuprofen, diclofenac etc.
  • DMARDS (Disease modifying anti-rheumatic drugs) such as sulfasalazine, hydroxychloroquine, eternacept etc.
  • Corticosteroids such as prednisolone.
  • Antimetabolite agent such as methothrexate.

Chukwu Unique Onyinyechi (B.Pharm UPH)