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Juvenile Idiopathic Arthritis

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Juvenile idiopathic arthritis is an autoimmune condition in children below the age of sixteen years that causes swelling, stiffness and tenderness in the joints.

What Is Juvenile Idiopathic Arthritis (JIA)?

Juvenile idiopathic arthritis is an umbrella term for multiple types of arthritis that occurs in kids. If your child has swelling, stiffness in one or more of their joints that lasts at least six weeks, and all other potential causes for these symptoms have been excluded, they may be diagnosed with JIA. There are many types of juvenile idiopathic arthritis that vary by their symptoms and the number of joints that are typically affected during a flare. These include:

• Oligoarthritis - the most common form of JIA, oligoarthritis is characterised by having up to four joints in the body affected in the first six months of the disease. Typically these are large joints such as the knees and ankles. If no more joints are affected after six months, it is deemed “persistent” oligoarthritis, and if more joints become affected, it is called “extended” oligoarthritis.
  
• Polyarticular - polyarticular JIA affects five or more joints in the first six months, often involving both large joints and smaller joints such as those in the hands.
  
• Systemic - this tends to affect the whole body, often presenting with a high fever and a skin rash. Internal organs may also be inflamed. It is the least common type of JIA.
  
• Psoriatic arthritis - this involves swollen joints resulting from psoriasis, an immune disease where healthy skin cells are mistakenly attacked by the body. Psoriatic arthritis presents with red, scaly patches over the joints, and will have at least two of the following: inflammation of a finger or toe, pits or ridges in the fingernails, a first-degree relative with psoriasis.
  
• Enthesitis-related arthritis (ERA) - with ERA, arthritis is present alongside enthesitis, which involves the inflammation of the tendons and tissues near the joints. We typically see this in the hips, knees and feet.
  
• Undifferentiated JIA - having undifferentiated JIA means that either your symptoms do not fit into the criteria for the other types of juvenile idiopathic arthritis, or your symptoms match two or more of the JIA types.
  

What Causes Juvenile Idiopathic Arthritis?

The term ‘idiopathic’ means that it has an unknown cause or may arise spontaneously, so it is not currently known why juvenile idiopathic arthritis develops. There is evidence to suggest that your genetics and a presence of a gene called HLA antigen DR4 may increase your risk, although JIA is not considered to be a hereditary disease. Certain environmental factors (like viruses or bacteria) can also trigger the disease to activate. 

Signs And Symptoms Of Juvenile Idiopathic Arthritis

While we’ve detailed specific symptoms depending on the type of juvenile idiopathic arthritis you have above, children with JIA may experience:

• Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints
  
• Symptoms often present in the morning or after a nap
  
• Eye inflammation
  
• Warmth and redness in a joint
  
• Less ability to use one or more joints
  
• Fatigue
  
• Decreased appetite, poor weight gain, and slow growth
  
• High fever and rash (in systemic JIA)
  
• Swollen lymph nodes (in systemic JIA)
  

What Is The Outlook For Kids With Juvenile Idiopathic Arthritis?

Unlike rheumatoid arthritis that is also a type of autoimmune arthritis and presents with recurrent flares throughout a lifetime, many children will outgrow their JIA. As childhood and adolescence is a crucial time for children’s growth and musculoskeletal development, JIA does have the potential to negatively (and permanently) interfere with the growth process - and where good management from a multidisciplinary care team can be of immense value.

Diagnosing Juvenile Idiopathic Arthritis

A diagnosis for JIA is typically done with your doctor and/or rheumatologist. There is no single test to confirm JIA, and other causes of joint swelling and your symptoms should be ruled out. You’ll likely have multiple blood tests, and depending on how long the symptoms have been present, imaging scans may be requested to assess any existing damage.

Managing Juvenile Idiopathic Arthritis

As there is no cure for JIA, medical treatments focus on managing any symptoms during and between flares to help children live a normal life. This is best done with a multidisciplinary team management approach where podiatry is an important part, given the common effects of arthritis on the feet.

Our goal here at The Feet People is to help children stay mobile and active with as little disruption to their everyday lives. We work to help maintain or improve their comfort on their feet, while supporting healthy muscle and joint function. As kids love to run and play, it’s important to help them keep up with their peers and participate in social activities wherever possible. We also work to help limit any damage that may have future consequences for their mobility or quality of life.

Every child under the expert care of our podiatry team across our Brisbane CBD and Newmarket clinics has a tailored treatment plan that is specific to their symptoms and how their arthritis is affecting them during and in-between flares. By working with our podiatrists, your child will:

• Have access to leading treatments like MLS laser which is shown to help reduce pain and inflammation
  
• Have their structural alignment in their feet and legs monitored and preserved as best possible, as it can degrade as a result of swelling in the joints or tendons.
  
• Have any gait (movement) changes caused by alignment problems treated promptly.
  
• Have access to custom foot orthotics where clinically indicated to help improve stability, comfort and offload painful joints - or any deformities or prominences that may result
  
• Know the best shoes to be wearing to optimise their foot comfort and best manage their symptoms 
  
• Have a list of prescribed stretching and strengthening exercises to support their recovery. Evidence suggests that children with JIA should still participate in 60 minutes of exercise per day, the same as children without JIA.
  
• Be closely monitored for symptom progression, so we can make timely referrals to help your child get the best care at the right time.