Juvenile idiopathic arthritis (JIA) describes a group of chronic paediatric inflammatory arthritides. There are several subtypes, including oligoarticular, polyarticular, and systemic onset.
Affects 1 in 1000 children and can present at any age.
Diagnosis is made clinically. Laboratory and radiographic testing provide classification and prognostic information but are not diagnostic.
The primary goals of treatment are to relieve immediate pain and prevent joint damage and therefore disability. Intra-articular corticosteroids offer good control if only a few joints are affected. Methotrexate is the most commonly used conventional synthetic disease-modifying antirheumatic drug. Physiotherapy, occupational therapy, and psychology form an important aspect of management.
Around 10% to 20% of children with JIA are at risk of developing anterior uveitis. All children with a diagnosis of JIA must undergo regular ophthalmological examinations to detect and manage inflammation.
A collection of chronic paediatric inflammatory arthritides characterised by onset before 16 years of age and the presence of objective arthritis (in one or more joints) for at least 6 weeks.
Arthritis of joints is defined by swelling or effusion, increased warmth, and/or painful limited movement with or without tenderness.
History and exam
Key diagnostic factors
- presence of risk factors
- more than 6 weeks' duration
- joint pain
- joint swelling
Other diagnostic factors
- age under 6 years
- morning stiffness
- limited movement
- limb length discrepancy
- rheumatoid nodules
- female sex
- human leukocyte antigen (HLA) polymorphism
- family history of autoimmunity
- antibiotic exposure in childhood
1st investigations to order
- erythrocyte sedimentation rate
- C-reactive protein
- antinuclear antibodies (ANA)
- rheumatoid factor (RF)
Investigations to consider
- anti-cyclic citrullinated peptide antibody
- chlamydia test
- ferritin levels
- ultrasound of affected joints
polyarticular JIA: 5 or more joints ever involved
oligoarticular JIA: 4 or fewer joints ever involved
- Septic arthritis
- 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis
- 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: recommendations for nonpharmacologic therapies, medication monitoring, immunizations, and imaging
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