When Your Child Has Juvenile Arthritis (JA)

Your child has been diagnosed with juvenile rheumatoid arthritis (JA). JA is also known as juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA). JA means that the lining of 1 or more of your child’s joints is inflamed, causing pain and swelling. JA affects children between ages 1 and 16. Most often, it develops in children younger than age 5. JA is a chronic condition, meaning that there is no cure. But the symptoms of the condition can be managed to help your child live a normal life. A child with JA may be referred to a healthcare provider who treats musculoskeletal disorders in children (pediatric rheumatologist). Or your child may see a healthcare provider who treats bone and joint problems in children (pediatric orthopedist).

What causes JA?

JA is an autoimmune disease. This means your child's immune system starts attacking the body’s own cells. The cause of this disease is currently not known. JA tends to run in families. And girls develop JA twice as often as boys.

What are the symptoms of JA?

JA has flare-ups and remissions. This means that the symptoms come and go over time. Symptoms may include:

• Swollen, stiff joints, especially after waking from sleep

• Sore or painful joints, often knees or joints in the hands or feet

When the disease first appears, the child may have symptoms that affect the whole body (systemic). These can include a fever that spikes and then goes down, a pink rash that comes and goes, and swollen lymph nodes.

How is JA diagnosed?

The healthcare provider will examine your child. They will also ask about your child’s health history and symptoms. For a diagnosis of JA, joint swelling or pain must last for at least  6 weeks at a time and all other possible conditions ruled out. Your child must also be younger than 16 years old.

There is no specific test to diagnose JA. But certain tests can help with the diagnosis:

• An X-ray, MRI, or bone scan looks for changes in bones or swelling in joints.

• Blood tests are sometimes done to check for certain “markers” (signs) of the disease. Blood tests can also rule out other conditions that may cause joint pain.

• Other tests may be done to rule out other possible conditions.

• An eye exam is done when JA is diagnosed. JA can affect the eyes, so the child’s eye health will need to be monitored regularly.

How is JA treated?

A team of healthcare providers is often involved in treating JA. This team may include the child’s pediatrician or family healthcare provider, an orthopedist, and a rheumatologist. The goal of JA treatment is to control symptoms and prevent damage to the joints. Treatment choices include the following.

Exercise

Staying active helps maintain healthy muscles. It also helps keep good range of motion in the joints. During flare-ups, your child may not be as active because of the pain. Your child should not do certain activities during flare-ups. This will protect the joints. Your child’s healthcare providers can discuss this with you.

Medicines to control symptoms

Your child may need to take medicines regularly to prevent and control symptoms. They include:

• NSAIDs (non-steroidal anti-inflammatory drugs). These include aspirin, ibuprofen, and other medicines that are available over the counter. The healthcare provider will prescribe the dose. Don't give aspirin to a child with a fever.

• DMARDs (disease-modifying antirheumatic drugs). These may be prescribed if NSAIDs don't ease symptoms. DMARDs help keep symptoms from getting worse. But they may take weeks or months to ease symptoms. Because of this, they are often taken along with an NSAID. Your child will need to be closed monitored when taking these medicines.

Medicines for flare-ups

Corticosteroid medicines are usually used for a flare-up. They are taken by:

• Injection. The healthcare provider removes fluid from the joint. They then inject corticosteroid medicine into the joint.

• Mouth or IV. These medicines help control severe symptoms. Corticosteroids shouldn’t be used for long periods or stopped suddenly. Your child's healthcare provider will tell you how your child should take these medicines and how to safely lower the dose.

Physical therapy

A program of regular exercises, joint movement, and massage may help ease symptoms and prevent flare-ups. You and your child will work with a rehabilitation specialist (physiatrist) or a physical therapist to design this program. Physical therapy can help ease symptoms during flare-ups.

Range-of-motion exercises help your child’s joints stay flexible.

Splinting

Your child may need to wear a splint over the affected joint to help protect the joint and ease symptoms. If a splint is prescribed, your child usually wears it only at home so they don’t have to feel “different” in school or at play.

What are the long-term concerns?

A child with JA needs regular checkups throughout childhood to help prevent problems. This includes regular eye exams and monitoring of the kidneys. The healthcare team will watch for growth problems in the affected joints. And the affected joints need close monitoring throughout your child’s life. Damage to the joint may eventually require a joint replacement. Your child can help control any damage by managing symptoms and getting physical therapy.

Coping with JA

JA can affect your child’s progress in school and social development. It also may affect other members of the family. To help make things easier:

• Treat your child normally and the same as other siblings. Don't give your child with JA “special” treatment.

• Explain to your child that JA is not their fault. Nothing they did caused the disease.

• Follow all instructions and don’t change the treatment plan without talking with your child’s healthcare provider or other member of the healthcare team. Don’t make changes based on another parent’s suggestion. What works for one child may not work for another.

• If prescribed medicines cause side effects or don’t ease symptoms, ask your child’s healthcare provider about other choices.

• Work closely with your child’s school to educate the teacher and your child’s classmates about JA. Some children with JA are absent from school for long periods during flare-ups. Work with your child’s school and teachers to help keep your child from falling behind. For example, you may want to keep an extra set of textbooks at home.

• Encourage your child to take part in exercise and activities. Team sports or other group activities help keep the joints strong and flexible. They also help your child develop social skills.

• Look into joining a support group for parents and children with JA. These groups give your child the chance to meet other children with the disease. They also allow you to talk to other parents who are coping with JA.

• Consider counseling for you and your child. Having a chronic disease can be very hard to deal with. Talking with a professional can help you and your child work through emotions like fear, sadness, and anger.

• For more information, contact the Arthritis Foundation at www.arthritis.org.