By Arielle Hay, MD
Chief of the Section of Rheumatology

Arthritis is often considered a health condition that affects adults. However, according to the American Academy of Orthopedic Surgeons (AAOS), almost 300,000 children cope with the joint pain, swelling and limited mobility associated with arthritis in the U.S. alone. Though there are many forms of arthritis in children, they are typically classified under the term juvenile arthritis.

Juvenile Arthritis vs. Adult Arthritis

When arthritis impacts children, it tends to look a little different than it does in adults. The most common form of arthritis in adults is osteoarthritis, which results from joint material in the body breaking down over time. Obviously, this scenario is fairly uncommon in children. Instead, juvenile arthritis is typically the result of an autoimmune disorder, where the body’s own immune system attacks its cells and tissues.

Currently, juvenile arthritis is comprised of six forms of the condition:

• Oligoarticular: This makes up about 50 percent of juvenile arthritis cases and impacts just a few joints in the body. Common symptoms are pain, stiffness and limited mobility in joints such as the knees or ankles. Eye inflammation is another possible symptom of this form of juvenile arthritis.
• Polyarticular: Polyarticular juvenile arthritis has similar symptoms to oligoarticular juvenile arthritis, but it impacts five or more joints in the body. The joints typically affected include the knees, ankles, hands and feet. This makes up about 30 percent of total juvenile arthritis cases.
• Systemic: In addition to pain, swelling and limited motion in at least one joint, children with systemic juvenile arthritis may experience rash, as well as inflammation of internal organs such as the spleen, liver, heart and lymph nodes. A telltale sign of systemic juvenile arthritis is a high fever (102 degrees or more) that lasts for at least two weeks. This form makes up 20 percent of juvenile arthritis cases.
• Psoriatic: This is usually the combination of arthritis and psoriasis. Psoriasis may be present before or after joint symptoms appear.
• Enthesitis-related: More common in boys and often affects the lower back and pelvic joints. This form of arthritis can also cause inflammation where tendons attach to bones, known as enthesitis.
• Undifferentiated: People with this form don’t fit perfectly in one of the other categories, or might fit in more than one category of juvenile arthritis.

Diagnosing Juvenile Arthritis

According to the American College of Rheumatology, diagnosing juvenile arthritis can sometimes be challenging. That’s because the disease cannot be immediately diagnosed with a blood test, and sometimes the symptoms can overlap with other common childhood medical conditions. If parents notice any of the symptoms mentioned above, it’s important that they schedule an appointment with their pediatrician and ask for a referral to our team of specialists if they suspect juvenile arthritis.

Treatments

The good news about juvenile arthritis is that, once a diagnosis is made, the treatments have improved dramatically in recent years. Some forms of juvenile arthritis can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), while others may require steroid injections to manage joint pain, swelling and stiffness.

In many cases drugs known as disease modifying anti-rheumatic drugs (DMARDs) are used to treat the inflammation and prevent joint damage. The most commonly used DMARD in JIA is methotrexate. Newer classes of drugs known as biologics target specific areas of the immune system to stop the inflammation and are also used frequently to treat JIA.

In addition, physical therapy, regular exercise, eating a nutritious diet and other healthy lifestyle habits are important for children with juvenile arthritis. We find that many children who manage their symptoms through medication and other healthy habits can live a normal, active lifestyle.