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An in-depth look at Juvenile Arthritis

What is juvenile arthritis?

Children can get arthritis just like adults. Arthritis is caused by inflammation of the joints. It causes pain, swelling, stiffness and loss of motion.

Juvenile arthritis is the term used to describe any form of arthritis or an arthritis-related condition that develops in children or teenagers who are less than 18 years of age.

The most common type that children get is Juvenile Idiopathic Arthritis (JIA).  Idiopathic means “from unknown causes”.

There are other forms of arthritis affecting children, including Juvenile Rheumatoid Arthritis.

Who Gets Juvenile Arthritis?

Juvenile arthritis affects children of all ages and ethnic backgrounds. In the UK, about 12,000 children have arthritis.

  • More than 2,500 children develop Juvenile Idiopathic Arthritis each year.
  • Around 15,000 children in the UK have ongoing problems with Juvenile Idiopathic Arthritis and related conditions.

Are all joint pains due to Juvenile Idiopathic Arthritis?

No, not all joint pains are due to arthritis and not all forms of arthritis are Juvenile Idiopathic Arthritis. Joint pains in young people are common and in most cases don’t last long and cause no long-term problems. In fact, it’s really uncommon for arthritis to be the cause of joint pain in children and young people.

Want to learn more about Juvenile Arthritis?
We look in more details below at the types, symptoms, diagnosis, causes, treatment and how osteopathy can help.

If you want to find out more about arthritis in adults, click on the appropriate box below:

Types of juvenile arthritis

There are several different types of Juvenile Idiopathic Arthritis, some of which are milder than others. You’ll need to know which type your child has because this will help your osteopath to plan the treatment and give advice.

Juvenile Idiopathic Arthritis presents with arthritic joint pain and, sometimes, other symptoms outside of joints (known as extra-articular symptoms). These include conditions causing eye inflammation and inflammation of the lining of the heart, lungs or abdomen. Juvenile Idiopathic Arthritis may also be associated with fever or symptoms of anaemia (such as feeling tired all the time).

Oligoarthritis – the most common type of Juvenile Idiopathic Arthritis

Oligoarthritis usually presents in children under 6 years old and is more common in girls.

  • It affects about two-thirds of children and young people with arthritis and most commonly affects one or both knees.
  • This form of arthritis is often mild and often starts with one or two swollen joints causing stiffness and reduced movement but often not much pain.
  • It affects typically four or fewer joints
  • It is the most likely to go away and leave little or no damage to the child’s joints.
  • There is a risk that children with the condition may develop eye problems, so it is recommended that they have regular checks with an ophthalmologist (an eye care specialist).
Polyarthritis – the second most common type of Juvenile Idiopathic Arthritis

Polyarthritis usually presents in pre-school children and those aged 10-13 years and is more common in girls.

  • This type of Juvenile Idiopathic Arthritis tends to cause painful swelling in fingers, toes, wrists, ankles, hips, knees, and the neck and jaw.
  • It may come on suddenly or can steadily involve more joints over a period of months.
  • The child may feel unwell and tired and occasionally develop a slight fever.
  • It affects five or more joints
  • The symptoms may continue into adult life but it can go into a state where all the symptoms disappear. This is called remission.
Systemic-onset – the rarest type of Juvenile Idiopathic Arthritis

Systemic-onset usually starts before the age of 5 but can affect children of any age.

  • In this form of arthritis, joint pain is part of a general illness involving fever, tiredness, rash, loss of appetite and weight loss.
  • A high fever often occurs, most often in the afternoon or evening, with a rapid return of the temperature to normal which may last for weeks or even months
  • A rash often appears with the fever. The rash is usually a light pink colour and quickly disappears.
  • The child may have enlarged glands in their neck, under their arms and around their groin area.
  • In the first few weeks there may be no sign of swollen joints, and the diagnosis may be uncertain. Lots of tests may be needed to confirm the diagnosis and this can be a worrying time.
  • Arthritis only occurs at the start of the disease in about one third of children but usually develops within a few months. The arthritis usually affects several joints.
  • The long-term development of this form of Juvenile Idiopathic Arthritis can be difficult to predict but usually the fever and rash will settle, although the arthritis may sometimes continue for several years before settling.
Enthesitis-related Juvenile Idiopathic Arthritis

Enthesitis-related arthritis tends to affect older boys or teenagers

  • This form of Juvenile Idiopathic Arthritis affects the places where tendons attach to the bone (these places are called entheses), causing inflammation.
  • It can cause pain in the soles of the feet and around the knee and hip joints where the ligaments attach to the bone.
  • Psoriasis, eye inflammation and bowel inflammation may also occur with enthesitis-related Juvenile Idiopathic Arthritis
Juvenile psoriatic arthritis

Psoriasis is a scaly skin rash, and with this you can also get joint pain known as psoriatic arthritis.  This affects girls twice as often as boys and tends to start at about 6 years of age.

  • This arthritis usually affects the fingers and toes, but it may affect other joints too.
  • Eye inflammation is also fairly common but it’s the painless type that doesn’t look red.
  • The joints may be affected before the skin rash appears – your doctor may look closely at the child’s fingernails and toenails for early signs of psoriasis and may ask if anyone in your family has the condition.
  • The arthritis affects both small and large joints. In over half of affected children, the arthritis starts before the psoriasis
Undifferentiated arthritis

Sometimes young people don’t fit neatly into the above groups and the condition is defined as undifferentiated arthritis. It may not seem a very useful category, but it’s one that doctors sometimes have to use.

Other Types of Juvenile Arthritis:

  • Juvenile Spondyloarthropies (ankylosing spondylitis, seronegative enthesopathy and arthropathy syndrome) are a group of diseases that involve the spine and joints of the lower extremities, most commonly the hips and knees.
  • Juvenile Dermatomyositis is an inflammatory disease that causes muscle weakness and a characteristic skin rash on the eyelids.
  • Juvenile Systemic Lupus Erythematosus is an auto-immune disease associated with skin rashes, arthritis, pleurisy, kidney disease and neurologic movement.
  • Juvenile Vasculitis is an inflammation of the blood vessels and can be both a primary childhood disease and a feature of other syndromes, including dermatomyositis and systemic lupus erythematosus.

Symptoms of juvenile arthritis

The most common symptoms of juvenile arthritis are joint swelling, pain and stiffness that don’t go away. Usually it affects the knees, hands and feet, and it’s worse in the morning or after a nap. Other signs include:

  • Limping in the morning because of a stiff knee
  • Excessive clumsiness
  • High fever and skin rash
  • Swelling in lymph nodes in the neck and other parts of the body.

Most children with arthritis have times when the symptoms get better or go away (remission) and other times when they get worse (flare).  Flare-ups can happen after viral infections, stress, changes in medication or sometimes for no apparent reason. Flare-ups can reduce the child’s appetite, may cause anaemia, and make the child feel ‘run down’ and tired.

Arthritis in children can cause eye inflammation and growth problems. It also can cause bones and joints to grow unevenly.

Sometimes having arthritis can cause problems with everyday activities and can have an effect on the child’s general health.

Causes of juvenile arthritis

Juvenile arthritis is usually an auto-immune disorder. As a rule, the immune system helps fight off harmful bacteria and viruses. But in an auto-immune disorder, the immune system attacks some of the body’s healthy cells and tissues.

Scientists don’t know why this happens or what causes the disorder. There’s no clear evidence that it’s inherited, but we do know that genetics are a factor.

There’s also no evidence that an infection causes Juvenile Idiopathic Arthritis. Sometimes children and young people may have had a sore throat or other infection just before they developed Juvenile Idiopathic Arthritis, but as yet no link has been identified.

Scientists think that Juvenile Idiopathic Arthritis is due to a combination of genetic factors and trigger factors from the environment, for example an infection that hasn’t yet been identified.

It is not contagious and there is no evidence that foods, toxins, allergies or vitamin deficiencies play a role.

Diagnosis of juvenile arthritis

There is no single test to diagnose juvenile arthritis.  A diagnosis is based on a complete medical history and careful medical examination. Evaluation by a specialist – either a paediatric rheumatologist or a rheumatologist – is often required.  The child may have:

  • Blood tests – including a test for anaemia (which may occur with Juvenile Idiopathic Arthritis) and tests for inflammation (called ESR and CRP, which are often raised with Juvenile Idiopathic Arthritis). Blood tests may also be useful to see whether any infection (virus or bacteria) has caused the arthritis rather than  Juvenile Idiopathic Arthritis. Other blood tests are used to see if there is a positive test for chemicals which are markers for different types of inflammation. Examples of these markers are called antinuclear antibodies, RF and HLA
  • X-rays – which are normal in the early stages of Juvenile Idiopathic Arthritis but help to check for any other bone or joint problems such as infection or injury.
  • Ultrasound – to see if there is any fluid in the joint and the extent of arthritis of the joint.
  • Magnetic resonance imaging (MRI) scans – to show details of the damage to the joint and any changes of the bones surrounding the joints.
  • Aspiration of a joint – where the fluid from a swollen joint is removed to be tested in a lab, to check for possible infection.

Other tests such as a chest x-ray or a heart scan (called an echocardiogram) look for inflammation of the covering of the heart (pericarditis), which can occur in the systemic-onset type of Juvenile Idiopathic Arthritis.

Treatment of juvenile arthritis

There is no cure for arthritis but there are a number of treatments that can help slow down the condition’s progress.  It is recommended that you have a team of people looking after your child who include: paediatric rheumatologist, physical therapist – osteopath, occupational therapist, eye doctor, dentist, and dietician.  Management varies depending on the specific form of juvenile arthritis, but the primary goals of treatment will be to control inflammation, relieve pain, prevent joint damage and maximise functional abilities.

Medication can help relieve the symptoms of arthritis. In severe cases, surgery may be recommended.

It is important that your child remains physically active and stays involved in social activities and has an overall good quality of life – by eating healthily, exercising and getting enough sleep.

How will osteopathy help?

We work alongside any medical treatment your child is having and we work to get your child’s body moving again as well as it can.  We will assess your child and will develop a programme for their individual needs so that your child is able to do the activities they want and need to be able to do in their daily life.

With hands on treatment we look to stretch muscles and articulate joints improving the range of movement and encouraging circulation to the area to aid healing.  Improved range of movement of the joints can lead to decreased pain and more mobility.  We will check your child’s posture and give them exercises that will help make their muscles stronger and more flexible which in turn protects the joints.

More information can be found on the Kids Get Arthritis Too website

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