Juvenile Idiopathic Arthritis Program

Overview

Juvenile Idiopathic Arthritis (JIA) is a chronic disease characterized by persistent joint inflammation. The word "idiopathic" means that the cause of the disease is unknown. Symptoms of arthritis are pain, swelling, limitation of movement and morning stiffness. The term JIA includes all forms of persistent arthritis that occur in childhood and whose origin is unknown, begins before the age of 16 and lasts longer than 6 weeks. Different types of arthritis have been defined under the title of JIA. There are various types of JIA. These types are distinguished mainly by the number of joints involved (oligoarticular or polyarticular JIA) and the presence or absence of fever, rash, and other additional symptoms (systemic JIA).

Since joint inflammation and pain can also be seen in viral and bacterial infections, tumors and types of cancer (leukemia, lymphoma, bone cancers and non-bone cancers) and other rheumatic diseases, differential diagnosis must be made by eliminating all other diseases.

What are the Types of Juvenile Idiopathic Arthritis?

There are various types of JIA. These types are distinguished mainly by the number of joints involved (oligoarticular or polyarticular JIA) and the presence or absence of fever, rash, and other additional symptoms (systemic JIA).

Oligoarticular JIA

It is the most common JIA subtype. It is characterized by the involvement of fewer than 5 joints, including large joints (such as knees and ankles). Oligoarthritis usually begins before age 6 and is most common in girls. Some patients may develop serious eye complications such as inflammation of the vascular layer surrounding the eye (uveitis). In JIA, this condition may develop insidiously without causing symptoms such as pain or redness. Early onset of JIA and Anti Nuclear Antibody (ANA) positivity are risk factors for the development of uveitis.

Therefore, it is imperative that children at high risk have regular eye checks by an ophthalmologist using a special tool known as a slit lamp. The frequency of examinations is generally every 3 months and should be continued for a long time.

Polyarticular JIA

It is characterized by the involvement of five or more joints. It is divided into RF negative and RF positive JIA.
RF-Positive Polyarticular JIA
It is quite rare in children. It often causes symmetrical arthritis, especially affecting the small joints of the hands and feet, and then extending to other joints. It is much more common in girls than boys and its onset is usually after the age of 10.
RF Negative Polyarticular JIA
Any joint can be involved, and inflammation often occurs in both large and small joints.
Systemic JIA
Systemic JIA is characterized by fever, rash, and intense inflammation in various organs in the body, which can occur before or during the course of arthritis. Fever usually rises in the morning and evening. It is often accompanied by a maculopapular rash that settles on the trunk. The clinical feature that distinguishes sJIA from other JIA subgroups is fever of 39 °C or higher.
Other symptoms include muscle pain, enlargement of the liver, spleen or lymph nodes, and inflammation of the membranes around the heart (pericarditis) and lungs (pleuritis).

How to Diagnose Juvenile Idiopathic Arthritis?

The most important criteria when making the diagnosis are the presence of swelling in one or more joints lasting more than six weeks and joint stiffness that occurs after long-term rest.

What is the Treatment for Juvenile Idiopathic Arthritis?

The goal of treating Juvenile Idiopathic Arthritis is to reduce pain and stiffness, prevent deformities, and help your child maintain as normal and active a lifestyle as possible. Treatment for all types should be planned early, as soon as possible after the diagnosis is confirmed.
Depending on the type of juvenile idiopathic arthritis and the severity of the disease, medications are prescribed to reduce pain and reduce joint damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
Injection of steroids directly into the affected joint(s)
Disease-modifying anti-rheumatic drugs (DMARDS), such as methotrexate. These medications may also help psoriasis rash.
Biological drugs such as adalimumab or etanercept. These medications help cure arthritis all over the body and also help reduce inflammation in the skin from psoriasis.
Regular exercise
Physical therapy to improve and maintain muscle and joint function

Set

Pediatric Rheumatology: Prof. Dr. Ozan Özkaya
Dermatology: Dr. Lecturer Member Deniz Akkaya
Physical Therapy and Rehabilitation: Prof. Dr. Berna Tander
Related Departments
Pediatric Orthopedics
Physical therapy and rehabilitation
Pediatric Eye Diseases
Pediatric Hematology and Oncology
Radiology