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Table of Contents
Common Symptoms
Does Treatment Cure It?
Onset
Signs in a Child
Into Adulthood
Juvenile idiopathic arthritis (JIA) is arthritis that affects children and whose cause is unknown (idiopathic).It has six subtypes that vary in symptoms.
All JIA subtypes cause joint pain, swelling, and stiffness. Some subtypes cause systemic symptoms like fatigue and fever. Skin rash, eye inflammation, and inflammation of the areas where tendons and ligaments attach to bone may also be seen in some subtypes.
JIA is a chronic (long-term) disease that can affect joints and tissues throughout the body. It may resolve in childhood or symptoms may continue into adulthood. It is also called childhood arthritis or juvenile arthritis.
Juvenile idiopathic arthritisis an autoimmune disease in which the body’s immune system mistakenly attacks the synovium. This tissue lines the inside of joints and encases the synovial fluid, which lubricates the joints and reduces friction between joints.When the synovial lining is attacked, the joints become swollen, painful, and stiff.
Symptoms of juvenile idiopathic arthritis may include:
Inflammation can also affect other areas of the body, including the eyes. Untreated or severe JIA can interfere with bone growth and development.
Symptoms of JIA Based on Subtype
There are six subtypes of juvenile idiopathic arthritis, each with unique symptoms. These subtypes are:
Oligoarticular JIA
Oligoarticular JIA affects one to four joints. It accounts for up to 70% of the JIA cases in children 6 and under and less than 40% of new JIA cases in children ages 12 to 15.About 80% of children with oligoarticular JIA will be affected in a single joint or both knee joints.
Oligoarticular JIA often occurs in the large joints in the lower limbs, but any joint can be affected. An early symptom of oligoarticular JIA is stiffness after periods of rest (naps, waking up in the morning, and other periods of inactivity). Oligoarticular JIA may also cause joint pain without apparent signs of swelling.
Additional symptoms of oligoarticular JIA include:
Polyarticular JIA
Polyarticular JIA will affect five or more joints. It is classified into two subtypes:rheumatoid factorpositive (RF) and rheumatoid factor negative.RF is an antibody that contributes to long-term inflammation. RF-positive polyarticular JIA is less common but more severe.
Polyarticular JIA shares similar symptoms to adultrheumatoid arthritis(RA). Polyarticular JIA causes inflammation in both large and small joints, but it often affects the hands and wrists.Affected joints will be:
Up to 10% of children with polyarticular JIA will develop uveitis.Uveitis can cause:
Psoriatic Arthritis
Juvenile psoriatic arthritis(PsA) affects 1 to 7% of children with JIA.It affects children withpsoriasisor a family history of the condition. Psoriasis is anautoimmune skin diseasethat causes scaly rashes.
Children with PsA may experience the following symptoms:
Human leukocyte antigen B27(HLA-B27) blood tests can support a diagnosis of juvenile PsA.HLA-B27 is a protein found on the surface of blood cells that helps the immune system distinguish between healthy cells and foreign invaders.
A positive HLA-B27 result could mean an increased risk for PsA, ankylosing spondylitis, orinflammatory bowel disease(IBD) (long-term inflammation of the digestive tract).However, not everyone who is HLA-B27 positive will develop these conditions.
What Is the HLA-B27 Test for Ankylosing Spondylitis?
Enthesitis-Related Arthritis
Enthesitis-related arthritis (ERA) accounts for 5% to 30% of all cases of JIA.Children with this type of JIA will experience inflammation at the entheses. It is similar to adult spondyloarthritis, which affects the spine and joints.
ERA JIA causes symptoms in the lower back, knees, ankles, and hips. When it affects the spine and lower back, it is calledjuvenile ankylosing spondylitis(AS).Juvenile AS is a systemic disease, which means it may affect other body areas, including the organs.
ERA JIA can cause:
An abnormal HLA-B27 can support a diagnosis of an enthesis-related arthritis like ankylosing spondylitis.
Juvenile Ankylosing SpondylitisAnkylosing spondylitis, also called axial spondyloarthritis, is an inflammatory disease that, over time, causes the bones of the spine (the vertebrae) to fuse.This fusing makes the spine less flexible and causes a hunched appearance. The fusing might be severe enough to affect the rib cage, making it difficult to breathe deeply.While AS is not considered a type of JIA, it can affect children and teens. About 10% to 20% of people with the condition will have symptoms before age 18.
Juvenile Ankylosing Spondylitis
Ankylosing spondylitis, also called axial spondyloarthritis, is an inflammatory disease that, over time, causes the bones of the spine (the vertebrae) to fuse.This fusing makes the spine less flexible and causes a hunched appearance. The fusing might be severe enough to affect the rib cage, making it difficult to breathe deeply.While AS is not considered a type of JIA, it can affect children and teens. About 10% to 20% of people with the condition will have symptoms before age 18.
Ankylosing spondylitis, also called axial spondyloarthritis, is an inflammatory disease that, over time, causes the bones of the spine (the vertebrae) to fuse.This fusing makes the spine less flexible and causes a hunched appearance. The fusing might be severe enough to affect the rib cage, making it difficult to breathe deeply.
While AS is not considered a type of JIA, it can affect children and teens. About 10% to 20% of people with the condition will have symptoms before age 18.
Systemic JIA
Systemic JIA, also known as systemic-onset JIA, is a rare autoimmune disease that accounts for 10% to 15% of JIA cases.It is considered the most serious of the JIA subtypes.
Symptoms of systemic JIA include:
Undifferentiated JIA
Undifferentiated JIA is JIA that does not fit into any of the other subtypes or when symptoms cover two or more subtypes. One study found that this subtype was one of the more prevalent forms of JIA.
The symptoms of undifferentiated JIA will not match perfectly with those of the other subtypes. However, inflammation will be present in one or more joints.
Diagnosing JIA
For a child to be diagnosed with JIA, symptoms must begin prior to age 16. However, JIA can be hard to diagnose because many children do not complain of joint pain.This is because children do not always know what is normal and what is not, and, in turn, their symptoms may go undetected.
Further, systemic symptoms like fatigue or fever may not be evident at first or may be mistaken for other conditions, including infections and illnesses.
For a diagnosis of JIA to be confirmed, the child must show clear signs of joint pain and swelling.Sometimes, blood work can help to confirm JIA, including ERA, PsA, and RF-positive polyarticular JIA. Imaging may show early signs of joint and bone damage or inflammation of the joints and soft tissues.
Does Treatment Cure JIA?
There is no cure for JIA, but treatment can help your child to feel better. Treatment goals for JIA may include:
Some newer treatments for JIA can help prevent disease complications, such as joint damage and growth problems.
Medications used to treat JIA include:
Your child’s healthcare provider will also recommendphysical therapy exercisesto relieve pain and improve muscle and joint strength.Aphysical therapistcan help develop a home exercise program for your child.
Most children with JIA will have normal life expectancies.However, children with systemic JIA are at higher risk for disease complications, such as an aggressive inflammatory response calledmacrophage activation syndrome, lung and heart problems, and bone and joint damage. Fortunately, an early diagnosis and aggressive treatments can allow most children to live healthy and productive lives.
Long-Term Risks of Untreated JIAJIA causes inflammation that affects the inside linings of the joints and the synovial fluid within them. These effects lead to swelling, pain, and stiffness. Left untreated, JIA can cause bone and joint damage.That same inflammatory process can occur in bone, cartilage, and other body areas, including the skin, eyes, and other organs. JIA can also interfere with the child’s growth and development.However, treatment can prevent JIA joint damage and other disease complications. If you suspect your child has JIA, contact their pediatrician right away.
Long-Term Risks of Untreated JIA
JIA causes inflammation that affects the inside linings of the joints and the synovial fluid within them. These effects lead to swelling, pain, and stiffness. Left untreated, JIA can cause bone and joint damage.That same inflammatory process can occur in bone, cartilage, and other body areas, including the skin, eyes, and other organs. JIA can also interfere with the child’s growth and development.However, treatment can prevent JIA joint damage and other disease complications. If you suspect your child has JIA, contact their pediatrician right away.
JIA causes inflammation that affects the inside linings of the joints and the synovial fluid within them. These effects lead to swelling, pain, and stiffness. Left untreated, JIA can cause bone and joint damage.
That same inflammatory process can occur in bone, cartilage, and other body areas, including the skin, eyes, and other organs. JIA can also interfere with the child’s growth and development.
However, treatment can prevent JIA joint damage and other disease complications. If you suspect your child has JIA, contact their pediatrician right away.
When Does Chronic Childhood Arthritis Begin?
According to the American College of Rheumatology, JIA affects 1 in 1,000 children in the United States.It occurs when the child’s immune system becomes overactive, causing inflammation that leads to joint pain and swelling.
JIA affects children 16 and younger, with average age of onset of 2 to 5 years old.It can affect children as young as 6 months old.
Some children may experience JIA for a few months or years.For others, JIA can last for many years or become adult arthritis.
Spotting Signs in a Child
Symptom Intensity During Flares
Children, especially younger ones, may not speak up when they have flares, so it is vital to pay attention to times when your child is feeling out of sorts.
Signs of a JIA flare may include:
If your child is experiencing a flare-up, they will need to rest and limit activities until their flare has subsided. Light activity is still a good idea for maintaining strength and activity.
If your child’s healthcare provider has approved it, give your child an OTC pain reliever to help alleviate pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil and Motrin (ibuprofen), can also help bring down fever.Never give aspirin to a child.
Hot and cold compresses can also manage JIA flare symptoms. Use cold for painful and inflamed joints and heat to increase blood flow to joints and muscles, alternating between the two therapies for no more than 15 minutes at a time and with breaks in between.
Call your child’s healthcare provider if symptoms do not improve in a couple of days. They can prescribe a corticosteroid for better relief or adjust regular treatments to reduce future JIA flares.
Child Arthritis Into Adulthood
With appropriate treatment, JIA may go away, but it may also persist into adulthood. Unfortunately, it is difficult to predict which children will experience disease remission and which ones will continue to treat into adulthood.
One 2020 Norwegian study followed young Norwegians with JIA for 18 years.In that study, 46% of study participants still had active disease and needed to continue taking medications. Around 33% achieved remission and were able to discontinue treatment.
Polyarticular-type JIA is considered to be early-onset rheumatoid arthritis, and it may worsen and progress as the child grows.Other types of JIA, such as psoriatic arthritis and enthesis-related JIA, may also become adult arthritis.
JIA can also become adult-onsetStill’s disease, an adult form of systemic JIA.Still’s disease is a rare type ofinflammatory arthritisthat causes fevers, sore throats, skin rash, and joint pain.
Early Diagnosis and TreatmentEarly diagnosis and appropriate treatment can help improve a child’s outcomes.
Early Diagnosis and Treatment
Early diagnosis and appropriate treatment can help improve a child’s outcomes.
Summary
Juvenile idiopathic arthritis is arthritis in children 16 and under. The six subtypes of JIA are oligoarticular JIA, polyarticular JIA, psoriatic arthritis, enthesitis-related arthritis, systemic JIA, and undifferentiated arthritis.
All subtypes cause joint pain, swelling, and stiffness. Other subtypes can cause systemic symptoms like fatigue and fever. Some cause skin rash, eye inflammation, and inflammation of the areas where tendons and ligaments attach to bone.
Some children experience JIA for months or years, while others may have a disease that continues into adulthood.
Left untreated, JIA can lead to severe complications, including growth problems and joint damage. Treatment can help to control inflammation and pain, maintain function, and prevent joint damage and other disease complications. If you suspect your child’s symptoms may be due to JIA, contact their pediatrician right away.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Arthritis Foundation.The link between HLA-B27 and arthritis.
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Children’s Hospital of Philadephia.Juvenile ankylosing spondylitis.
Hospital for Special Surgery.Systemic juvenile idiopathic arthritis.
Kasapçopur Ö, Barut K.Treatment in juvenile rheumatoid arthritis and new treatment options.Turk Pediatri Ars. 2015;50(1):1-10. doi:10.5152/tpa.2015.2229
Arthritis Foundation.Juvenile arthritis-related skin symptoms vary.
Horneff G, Borchert J, Heinrich R, et al.Incidence, prevalence, and comorbidities of juvenile idiopathic arthritis in Germany: A retrospective observational cohort health claims database study.PediatrRheumatol Online J. 2022;20(1):100. doi:10.1186/s12969-022-00755-x
Arthritis Foundation.Treatments for juvenile arthritis.
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American College of Rheumatology.Juvenile arthritis.
American Academy of Pediatrics Section on Rheumatology.Juvenile idiopathic arthritis.
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National Institute of Neurological Disorders and Stroke.Reye’s syndrome.
UPMC HealthBeat.Should you use ice or heat for joint pain?
Oliveira-Ramos F, Eusébio M, M Martins F, et al.Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases, long-term outcomes and predictors of inactive disease, functional status and damage.RMD Open. 2016;2(2):e000304. doi:10.1136/rmdopen-2016-000304
National Organization of Rare Disorders.Adult-onset Still’s disease.
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