The Indian Rheumatology Association
The Professional Organization of Rheumatologists and other Health Professionals in India
Juvenile Idiopathic Arthritis

What is juvenile idiopathic arthritis ( JIA )
JIA is the most common cause of chronic (lasts more than 6 week) arthritis in children. It is of different types depending on the clinical signs and symptoms. In JIA child has joint pain associated with swelling and along with this may have fever, skin rash, lymph node enlargement, backache, red eye, or pain in sole/heel.

Why did my chlid get it?
The exact reason why it occurs is not know. Genetic and environmental factors are thought to play a role but it is not a hereditary disease as only 5% of children have a family history.

What are its common symptoms?
It usually with joint pain associated with swelling, which may involve one to several joints. The child may have malaise, fever fatigue and stiffness in the morning. Some children have high grade fever, skin rash and gland enlargement along with joint pain.

How is it diagnosed?
There is no diagnostic test for JIA. The diagnosis is made by presence of symptoms and signs. Some simple tests are done to excule other diseases and to know the severity of disease.

How is it treated?
To provide immediate pain relief most children are treated with NSAIDs like Naproxen, Ibuprofen etc. In a child with a few joint affected injection of cortisone into the joint is an affective way of controlling disease. Since it is chronic disease a significant proportion of children require disease modifying drugs like Methotrexate. Other drugs used are Salazopyrin, Leflunomide and biologics. Along with medication the child needs balanced diet, splints to prevent contractures, physiotherapy and psychological support.

What dietary precautions should the child take?
No relationship between any special food and JIA has been shown. Potato, pulses etc do not increase joint pains. Balanced diet is must for maintenance of muscle mass, bone strength and adequate hemoglobin in blood. A child who is getting cortisone should avoid food rich in fat and salt.

How long would my child need to take medication?
In oligoarticular variety of JIA the child may need only short term treatment but in majority, long term treatment is required. Drugs are gradually reduced after the disease is controlled and can be stopped once the disease is in remission for 1 year. In some types of JIA treatment is given for long term.

Can the disease be cured?
About one third of children may outgrow the disease and may not have symptoms in adulthood. In the rest the disease follows a relapsing remitting course. In a small fraction the disease may be present throughout.

Can my child go to school?
All effort should be made to help the child attend school and indeed most children with JIA can attend school. Some children may need assistance during disease flares. A discussion with the class teacher often helps.

Will my child be able to do job?
If the disease is managed early and well, most children can study and do a profession. However some children have physical limitation and thus cannot do jobs that involve manual labor. It is good to have a session with your physician when you are making decision regarding career.

What is the long term outcome of this disease?
JIA is a disease with good outcome however 50% of children would have some joint pains during adulthood. Most children can attain good education level and are employable. Good outcome depends on early and effective treatment to control disease activity.

What are its complications?
In systemic variety ( So JIA ) child have fluid around the heart ( pericarditis ) around lungs (pleuritis), myocarditis, marked weight loss rarely a serious condition called macrophage activation syndrome. In other varieties limb length discrepancy, hip joint damage and joint deformities may occur. Uveitis ( inflammation in eye ) can present with redness of eyes, blurring of vision or gradual visual loss. Thus regular eye checkup is needed.

Complications can also be related to therapy like weight gain, short stature, acne related to cortisone. Methotrexate, sulphasalazing and leflunomide may rarely cause lowering of blood counts or liver enzyme abnormalities.

Does it have any effect on puberty?
In most children if the disease is well controlled there is no impact on pubertal growth. In children with SoJiA or polyarticular JIA puberty may be delayed due to persistent disease activity.

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