- JIA: causes and risk factors
- Juvenile Idiopathic Arthritis: Symptoms
- JIS: types
- JIA: complications
- JIA: diagnostics
- JIA: treatment
- JIA: prognosis
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Juvenile idiopathic arthritis is a group of diseases in which there are problems related to the joints, but not only - additional symptoms may concern, for example, the eye or internal organs. Unfortunately, the causes of this disease are not fully known. Treatment must be started as early as possible to prevent complications of the condition. What symptoms suggest juvenile idiopathic arthritis?
Juvenile idiopathic arthritis(abbreviatedJIA , juvenile rheumatoid arthritis, juvenile chronic arthritis, Still's disease. idiopathic arthritis (JIA) is an autoimmune disease - the most common form of arthritis in children and adolescents.
The disease may begin at different ages - the first symptoms of JIA may occur in a few-year-old as well as in a teenager - however, this disease can be talked about when it begins before the age of 16.
JIA it is not really one disease, but a group of several different diseases - depending on the number of affected joints, as well as additional extra-articular symptoms of the disease, there are several different types of this problem.
Overall - despite the fact that the first descriptions of juvenile idiopathic arthritis date back to 1896 - this disease is still a rather mysterious entity for doctors, about which medicine still does not know everything.
Girls suffer from JIA more often.
Statistics on the incidence of JIA vary, but overall the literature mentions that the disease affects more than 2 to 20 per 100,000 children.
JIA: causes and risk factors
The pathogenesis of juvenile idiopathic arthritis involves abnormal reactions of the body, i.e. those where the structures of the immune system begin to attack elements of the body's own (in this case, primarily the structures of the joints).
What, however, causes that a given patient has this type of pathological reaction - it is not known. In fact, one of the words in the name JIA, i.e. idiopathic, suggests that the causes of this individual are not entirely clear.
However, we have discovered certain factors that increase the risk of developing juvenile idiopathic arthritis. They are:
- family burden of rheumatic diseases: if someone in the child's family has suffered from an autoimmune disease (in particular rheumatoid arthritis), then the risk that the child will develop JIA is increased
- hormonal conditions: since JIA is more common in girls, some researchers have suggested that female sex hormones are associated with JIA
- stress: some scientists postulate that stress has an impact on the intensity of JIA symptoms - it has been noticed that under the influence of severe stress, patients' ailments may worsen (on the other hand, in patients with juvenile idiopathic arthritis who do not experience no stress, their condition does not always improve in any way, therefore the relationship between stress and JIA remains unclear)
There are many more concepts regarding the pathogenesis of JIA - only a few of them have been described above, and one can also come across the views that the occurrence of the disease is influenced by various viral infections experienced by children and adolescents.
Juvenile Idiopathic Arthritis: Symptoms
The primary symptoms of juvenile arthritis are swelling, pain and limited mobility in the inflamed joints.
Patients locate ailments in a wide variety of places - typically in the course of JIA, problems relate to the knee joints, however, hand joints, hip joints or other joints may also be affected.
The point in which the symptoms will be most severe depends to the greatest extent on the type of JIA in a given patient.
In addition to those already described, other symptoms may appear in the course of JIA, such as:
- morning stiffness (where patients experience the greatest limitation of mobility in the affected joints in the morning, and later - as the day progresses - the intensity of this problem decreases)
- flu-like symptoms (e.g. fever, general weakness)
Sometimes swelling of a joint is visible at first glance even to a layman, but this is not always the case. Parents say that their child's he alth is in danger more often than not based on the observation of their child's gait disturbance. It is not uncommon that the first distinct deviation that occurs in patients with JIA is limping.
JIS: types
The group of juvenile idiopathic arthritis usually includes six units:
- JIA with an onset of sparse joints - it is the most common form of the disease in this group, characterized by the fact that in the first six months after the onset of the disease, the inflammatory process affects up to four different joints; in most patients, the knee is inflamed
- JIA with polyarticular onset- in this unit, in the first six months of the disease, inflammation affects at least 5 joints; the inflammatory process typically affects large joints of the upper and lower limbs (e.g. shoulder or knee)
- JIA with systemic onset -This disease is associated with inflammation of various joints (both smaller and larger) and the presence of various general symptoms, such as fever , lymphadenopathy, hepato- and / or splenomegaly (hepatomegaly and / or splenomegaly), or serositis; patients may also develop a rash
- arthritis with tendinitis- this disease is diagnosed when arthritis is accompanied by tendinitis or when the patient has arthritis or tendinitis and at least two of the symptoms, such as soreness in the sacroiliac joints, uveitis or autoimmune enteritis
- juvenile psoriatic arthritis- this entity can be diagnosed when a young patient is diagnosed with psoriasis along with arthritis or when the patient suffers from arthritis and at the same time has e.g. psoriasis lesions in the area of the nails and one of his closest relatives has or suffered from psoriasis
- undifferentiated JIA- such a diagnosis is made when the patient's symptoms do not meet the criteria of any form of juvenile idiopathic arthritis or when the symptoms correspond to several different types of this diseases
JIA: complications
The very symptoms of juvenile idiopathic arthritis - such as joint pain and swelling - can be troublesome for patients, but worse, this disease can lead to various other complications.
First of all, they may concern structures directly affected by the disease process, i.e. joints. Patients may experience growth disorders - their limbs may be shortened compared to the he althy limb, but also elongated.
The second option may seem absurd, but it is quite possible - the inflammatory process sometimes leads to the activation ofand that is why the limb whose joint is inflamed may become longer than the one in which there were no pathological processes.
In addition to those described, JIA can also result in muscle contractures, joint deformities, loss of muscle mass, and even osteoporosis.
Complications of juvenile idiopathic arthritis, however, include not only the elements of the musculoskeletal system. Patients may experience, for example, uveitis - this problem is dangerous because it can be asymptomatic for a long time, and eventually it can lead to, for example, cataracts or even blindness.
Patients may suffer damage to various internal organs as a result of illness.
JIA: diagnostics
In the diagnosis of JIA, both imaging and laboratory tests are used. The first of these are used to determine the degree of the pathologies, among them ultrasound of the joints and magnetic resonance imaging play the most important role.
X-ray examination of the joints can also be used, although in the case of this diagnostic method, the most pronounced changes can be found only after a certain duration of the disease.
As for the laboratory tests that are ordered to patients with suspected JIA, their scope is exceptionally wide.
Patients can perform both the determination of inflammatory markers (such as ESR and CRP), but also blood count tests, tests of rheumatological markers (such as rheumatoid factor - RF, anti-CCP antibodies) or tests of histocompatibility markers HLA.
The scope of tests performed on patients who may suffer from JIA, however, is even wider.
The reason for such a situation is that, in principle, the diagnosis of one of these diseases is, in a way, made out of exclusion - it is necessary to eliminate other possible causes of the patient's symptoms, such as fractures, proliferative diseases involving the osteoarticular system or diseases infectious.
JIA: treatment
The treatment regimen of a patient with JIA depends both on the form of the disease and the degree of its severity. Most patients use non-steroidal anti-inflammatory drugs and intra-articular glucocorticoid injections.
In the treatment of juvenile idiopathic arthritis, so-called disease-modifying drugs (such as methotrexate and sulfasalazine) and biological drugs (such as rituximab or etanercept).
In patients with juvenile idiopathic arthritis very muchrehabilitation impacts are also important.
- Rehabilitation treatments for joints
In rare cases - especially in patients with severe complications of the disease - surgical procedures are used.
JIA: prognosis
It is difficult to say unequivocally what is the prognosis of patients with JIA. Permanent remission is achieved in some patients, while in others the disease becomes chronic and persists even despite optimal treatment.
One thing can be said for sure: thanks to the increased availability of intra-articular treatment with glucocorticosteroids, as well as the emergence of disease-modifying drugs and biological preparations, the effects of juvenile arthritis treatment are much better than even several decades ago.
Sources:
- "Pediatrics", edited by A. Dobrzańska, J. Ryżko, ed. Edra Urban & Partner, Wrocław 2014, 890-895
- David D Sherry, Juvenile Idiopathic Arthritis, Medscape, online access: https://emedicine.medscape.com/article/1007276-overview
- Kenan Barut et. al., Juvenile Idiopathic Arthritis, Balkan Med J. 2022 Mar; 34 (2): 90-101
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