Other JIA Resources

We are not trying to copy someone else’s research, we are trying to spread awareness about JIA and to share our story.

Systemic JIA.
Affects the whole body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. The spleen and lymph nodes might become enlarged. Eventually many of the body’s joints are affected by swelling, pain, and stiffness.

Read more at KidsHealth.org.

Children’s Mercy Hospital told us that there were a lot of websites that contain horror stories about JIA and to make sure we stick to this recommended reading.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children, and is one of the most common chronic diseases in childhood. Juvenile idiopathic arthritis (JIA), is a subgroup of JRA.

“Systemic” means that the JIA also affects other systems such as skin (rash) spiking fever which if not controlled, can cause possible liver damage.

Most of the information below was copied from Medscape: http://emedicine.medscape.com/article/1007276-overview which was on the list of recommended reading by our rhumatologist at Children’s Mercy Hospital in Kansas City, MO.

Signs and symptoms

History findings in children with JIA may include the following:

  • Arthritis present for at least 6 weeks before diagnosis (mandatory for diagnosis of JIA)
  • Either insidious or abrupt disease onset, often with morning stiffness or gelling phenomenon and arthralgia during the day
  • Complaints of joint pain or abnormal joint use
  • History of school absences or limited ability to participate in physical education classes
  • Spiking fevers occurring once or twice each day at about the same time of day
  • Evanescent rash on the trunk and extremities
  • Psoriasis or more subtle dermatologic manifestations

Physical findings are important to provide criteria for diagnosis and to detect abnormalities suggestive of alternative etiologies, as well as to indicate disease subtypes. Such findings include the following:

  • Arthritis: Defined either as intra-articular swelling on examination or as limitation of joint motion in association with pain, warmth, or erythema of the joint; physical findings in JIA reflect the extent of joint involvement
  • Synovitis: Characterized by synovial proliferation and increased joint volume; the joint is held in a position of maximum comfort, and range of motion often is limited only at the extremes

Types of JIA include the following:

  • Systemic-onset juvenile idiopathic arthritis
  • Oligoarticular juvenile idiopathic arthritis
  • Polyarticular juvenile idiopathic arthritis
  • Psoriatic arthritis
  • Enthesitis-related arthritis
  • Undifferentiated arthritis

Diagnosis

Diagnosis of JIA is based on the history and physical examination findings. When physical findings do not document definite arthritis, further evaluation is warranted. Laboratory studies that may be considered include the following:

  • Inflammatory markers: Erythrocyte sedimentation rate (ESR) or CRP level
  • Complete blood count (CBC) and metabolic panel
  • Liver function tests and assessment of renal function with serum creatinine levels
  • Antinuclear antibody (ANA) testing
  • Additional studies: Total protein, albumin, fibrinogen, ferritin, D-dimer, angiotensin-converting enzyme (ACE), antistreptolysin 0 (AS0), anti-DNAse B, urinalysis

When only a single joint is affected, radiography is important to exclude other diseases. Basic radiographic changes in JIA include the following:

  • Soft tissue swelling
  • Osteopenia or osteoporosis
  • Joint-space narrowing
  • Bony erosions
  • Intra-articular bony ankylosis
  • Periosteitis
  • Growth disturbances
  • Epiphyseal compression fracture
  • Joint subluxation
  • Synovial cysts

Other imaging modalities that may be helpful include the following:

  • Computed tomography
  • Magnetic resonance imaging
  • Ultrasonography and echocardiography
  • Nuclear imaging

Other studies and procedures that may be considered include the following:

  • Dual-energy radiographic absorptiometry (DRA)
  • Arthrocentesis and synovial biopsy
  • Pericardiocentesis

Management

A team-based approach to the treatment of JIA can be helpful. Management may include 1 or all of the following areas:

  • Pharmacologic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologic agents, or intra-articular and oral corticosteroids
  • Psychosocial interventions
  • Measures to enhance school performance (eg, academic counseling)
  • Improved nutrition
  • Physical therapy
  • Occupational therapy

American College of Rheumatology (ACR) criteria for complete remission are as follows:

  • No inflammatory joint pain
  • No morning stiffness
  • No fatigue
  • No synovitis
  • No progression of damage, as determined in sequential radiographic examinations
  • No elevation of the ESR and CRP level

The ACR recommends treatment approaches to JIA on the basis of the following 5 treatment groups:

  • A history of arthritis in 4 or fewer joints
  • A history of arthritis in 5 or more joints
  • Active sacroiliac arthritis
  • Systemic arthritis without active arthritis
  • Systemic arthritis with active arthritis

Within each group, choice of therapy is guided by the severity of disease activity and the presence or absence of features indicating a poor prognosis.

Advances in medical treatment have reduced the need for surgical intervention. Procedures that may be considered in specific circumstances include the following:

  • Synovectomy
  • Osteotomy and arthrodesis
  • Hip and knee replacement