Juvenile idiopathic arthritis (JIA) describes a group of chronic pediatric 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 disease-modifying agent. Physical therapy, 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 ophthalmologic examinations to detect and manage inflammation.
A collection of chronic pediatric inflammatory arthritides characterized 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
- over 6 weeks' duration
- joint pain
- joint swelling
Other diagnostic factors
- morning stiffness
- limited movement
- limb length discrepancy
- rheumatoid nodules
- female sex
- HLA polymorphism
- age under 6 years
- 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
- anticyclic 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
Jacqui Clinch, MRCP, FRCPCH
Consultant Paediatric Rheumatologist
Department of Paediatric Rheumatology
Bristol Royal Hospital for Children
JC declares that she has no competing interests.
Dr Jacqui Clinch would like to gratefully acknowledge Dr Ripal Shah, Dr Eve Bassett, Dr Sheila Angeles-Han, and Dr Sampath Prahalad, the previous contributors to this topic. RS and EB declare that they have no competing interests. SAH and SP are authors of a number of references cited in this topic. SP is the recipient of research funding from the National Institute of Health and Arthritis Foundation.
Paul Rosen, MD
Division of Pediatric Rheumatology
Children's Hospital of Pittsburgh
PR declares that he has no competing interests.
Murray Passo, MD
Division of Rheumatology
Professor of Pediatrics
Department of Pediatrics
Medical University of South Carolina
MP is an author of a number of references cited in this monograph. He is a consultant to Pfizer Pharmaceuticals as the chairman of the Expert Advisory Panel to review toxicity of celecoxib. He has been a visiting professor from the American College of Rheumatology, and from the American Academy of Pediatrics.
Patricia Woo, CBE
Professor of Paediatric Rheumatology
University College London
- Septic arthritis
- American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis
- EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice
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