Juvenile Idiopathic Arthritis (JIA)

What is juvenile idiopathic arthritis (JIA)?

Arthritis is a condition that we most commonly associate with older people, but it can also affect children.
JIA is inflammation (swelling) of one or more of your joints. It first occurs before your 16th birthday. It is slightly more prevalent in girls and most commonly occurs in pre-school age children or teenagers.

There are different types of JIA and symptoms vary between the different types.

There are some common features of all types of JIA. If you or your child have any of these symptoms for more than a couple of weeks, you should contact your doctor:

  • painful, swollen or stiff joint(s)
  • joint(s) that are warm to touch
  • increased tiredness
  • a fever that keeps returning
  • a limp but no injury

What are the causes of JIA?

The causes of JIA are not fully understood (in fact, that’s what ‘idiopathic’ means!), but it is known that JIA is an autoimmune disorder. Our immune system is our body’s way of defending itself against injury, illness or infection. Inflammation is one of the defence mechanisms that our immune system uses. In JIA, the body creates inflammation in a joint or joints when it doesn’t need to. This inflammation then causes stiffness and pain.

JIA is thought to be due to a combination of genetic factors and trigger factors from the environment, for example the infections that the immune system has been in touch with. There’s no evidence that a specific infection causes JIA, but an infection may trigger an immune system’s response that then carries on and affects joints.

What are the different types of JIA?

There are several different types of JIA, some of which are milder than others. Treatment and advice will vary, depending on which type you have.

Oligo-Articular JIA:
This is the most common type of JIA. It affects up to 4 joints in the body, most commonly knees, ankles and wrists.

Polyarticular JIA:
This is the second most common type of JIA and affects 5 or more joints. It can come on suddenly or develop gradually.

Systemic Onset JIA:
Systemic onset JIA starts with symptoms such as fever, rash, lack of energy, and enlarged glands. Later on, joints can become swollen and inflamed.

Enthesitis-related arthritis:
Enthesitis-related arthritis is a type of JIA that often affects the joints of the leg and spine, causing inflammation where the tendons attach to the bone. It can cause stiffness in the neck and lower back in the teenage years.

Psoriatic arthritis:
Psoriasis is a skin rash. A combination of joint pain and the rash is known as psoriatic arthritis. This type of JIA usually affects the fingers and toes but may affect other joints too.

If my child has JIA, how will they be affected?

Many children who have JIA won’t have any symptoms when they’re adults, but it’s not possible to accurately predict this. In most cases, childhood arthritis has a good outcome. In a smaller number of cases (approximately 30%), arthritis can remain active into adult life. Some young adults with JIA can have joint damage that limits their daily activities to some extent and a few may need joint replacements. Some people are physically smaller than average or have osteoporosis (low bone density) as a result of their arthritis and/or treatment with steroids.

What are the goals of JIA treatment?

  • Slow down or stop inflammation and prevent disease progression.
  • Relieve symptoms, control pain and improve quality of life.
  • Prevent or avoid joint and organ damage.
  • Preserve joint function and mobility for adulthood.
  • Reduce long-term health effects.

A well-rounded plan includes medication, physical activity and healthy eating habits.

Hydrotherapy is an ideal way to maintain physical activity, especially when weightbearing and land exercises prove difficult or too painful.

This is because:

  • The warmth of the water allows muscles to relax. This may ease pain in joints, making exercises easier.
  • Water supports your body weight. This can help relieve pain and increase the range of movement of your joints.
  • The water can be used to provide resistance to joint movement without the use of weights. By pushing your arms and legs against
  • the water, you can improve your muscle strength and tone and increase stability around joints.
  • Water exercises can help with cardiovascular function and improve proprioception (joint position sense).
  • The water can reduce stress on joints.
  • The buoyancy of the water can improve balance, coordination, posture, and trunk control, as well as kidney and respiratory function, and circulation.
  • The compression of the water can reduce joint and soft tissue swelling.