Juvenile idiopathic arthritis

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• Juvenile idiopathic arthritis
• Juvenile idiopathic arthritis is a common type of
  arthritis that affects children it is earlier
  known as juvenile rheumatoid arthritis. Children
  under 16 years of age are mostly affected.
• It is a chronic disease that affects any joint of
  the body. The immune system mistakenly targets
  synovium (synovium is a tissue that lines the
  inside of the joint). The synovium
• responds by making excess synovial fluid which
  leads to persistent joint pain, swelling, and
  stiffness. The inflammation and synovium spreads
  to the surrounding tissues and damage cartilage
  and bone.
• Some children may see the early symptoms only for
  a few months, while others have symptoms
  lifelong. Some categories of juvenile idiopathic
  arthritis can give rise to critical problems,
  such as growth and development problems, joint
  damage, and eye inflammation. Treatment is given
  to reduce pain and inflammation, improving the
  function of the joints, and preventing any
  further joint damage.
• There are many types of Juvenile idiopathic
  arthritis they are - Systemic arthritis,
  Oligoarthritis, Polyarthritis, Psoriatic
  arthritis, Enthesitis-related arthritis.
• Symptoms of JIA
• Depends on the type of JIA, the symptoms vary.
  Common symptoms are
• Morning stiffness you might have noticed that
  your child is unable to walk especially in the
  morning.
• Pain the child appears clumsier than usual
  mainly in the mornings and after taking nap.
• Swelling and tenderness in the joints it is
  mostly noticed in the larger joints such as knee.
• Limping, fever, rash, weight loss, fatigue, eye
  redness, and blurred vision these symptoms
  usually worsen in the evenings.
• Based on the symptoms and the number of joints
  affected the type of disease is identified.
• Symptoms come and go over days or weeks. When the
  child has less fever it seems to be fine. When
  it flares up, the child will feel sick. Children
  will have good days with very few or without any
  symptoms, and worse days with flare up
  symptoms.This condition might cause inflammation
  in the lining of the lung (pleuritis) or heart
  (pericarditis). It may

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• also cause swollen lymph nodes. Children with
  these conditions may grow slowly than normal.
• Causes
• Juvenile idiopathic arthritis occurs when our own
  body's immune system attacks its own cells and
  tissues. Research indicates that it is an
  autoimmune disease. White blood cells cant tell
  the difference between healthy cells and germs.
  Instead of protecting from these harmful
  invaders, it damages healthy tissues and cause
  inflammation and pain. It's unknown why this
  happens, but both heredity and environment seem
  to play a vital role in causing the disease.
  Certain gene mutations may make a person more
  vulnerable to environmental factors like viruses
  that are the triggering source of the disease.
• When to see a doctor?
• Consult the doctor by taking your child to him,
  if the child has joint pain, swelling or
  stiffness that is persists more than a week along
  with mild or high fever.
• Complications
• Many severe complications can come from Juvenile
  idiopathic arthritis. Therefore, keeping a
  careful watch on your childs condition and
  getting the medical treatment done at right time
  will reduce the complications.
• Eye problems Some types of JIA can cause eye
  inflammation (uveitis) which may result in
  cataracts, glaucoma and even blindness if it is
  not treated earlier. Inflammation in eye occurs
  without any symptoms therefore the child should
  be examined frequently by an ophthalmologist.
• Growth and bone development problems may occur
  with Juvenile idiopathic arthritis. Some
  medications that are utilized for treating JIA,
  mostly corticosteroids, also can hinder growth.
• Diagnosis

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• There are no tests done specifically to diagnose
  JIA. JIA is a diagnosis of exclusion that helps
  the doctor to rule out other diseases that have
  similar symptoms. To diagnose JIA, the doctor
  tries to understand the complete medical history
  that includes details of the symptoms and a
  complete physical examination. Imaging
  techniques such as X-rays or magnetic resonance
  imaging (MRI) is conducted to know the condition
  of the joints and reject other conditions, such
  as fractures, tumors, infection or congenital
  defects. Imaging may also be used after the
  diagnosis frequently to monitor bone development
  and to detect joint damage.
• Lab tests are done on blood, urine or joint fluid
  to find out the type of arthritis. These tests
  are
• Erythrocyte sedimentation rate this is a simple
  test done to measure the erythrocyte
  sedimentation rate that is how rapidly red blood
  cells settle to the bottom of the test tube with
  blood sample. The rate of settling will be
  faster if inflammation is in the body.
• CBC- a common blood test to know the basic cells
  types in blood which includes red blood cells,
  white blood cells, and platelets.
• C-reactive protein- it is protein which liver
  releases into the blood at the beginning of the
  infection or inflammation.
• Anti-nuclear antibody (ANA)- it is a blood test
  to find out autoimmune diseases. It also helps in
  predicting if the child is likely to have eye
  disease with JIA.
• Rheumatoid factor- it is an antibody occasionally
  found in childrens blood who have JIA
• Cyclic citrullinated peptide (CCP) - this is an
  antibody same like the rheumatoid factor found in
  childs blood who have JIA.
• HLA B27
• In most of the children with juvenile idiopathic
  arthritis, no significant abnormality will be
  found in these blood tests. These tests can help
  the doctor to rule out other diseases such as
  infections, bone disorder, cancer or any injury.
• Treatment
• Treatment for juvenile idiopathic arthritis will
  help your child to lead a normal level of
  physical and social activity. To achieve this,
  doctors may use different combinations to
  relieve pain and swelling, maintain full movement
  and strength, and avert complications. In few
  cases the child is given corticosteroid
  injections into the joint. In very rare cases,
  kids may require surgery.

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• Medications
• The main goal of treatment is to relieve pain,
  reduce swelling, and improve joint mobility and
  strength and also to prevent joint damage and
  complications. The treatment usually includes
  medications and exercises.
• Typical medications to treat JIA
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
  these medicines provide pain relief and reduce
  swelling, but will not affect the course of
  prognosis of JIA.
• Disease-modifying antirheumatic drugs (DMARDs).
  These medications are used to prevent bone and
  joint destruction by suppressing the immune
  systems attack on the joints.
• Biologic agents. This is also known as biologic
  response modifiers this newer class of drugs
  includes tumor necrosis factor (TNF) blockers,
  such as etanercept (Enbrel) and adalimumab
  (Humira). These medications directly target
  molecules or proteins in the immune system that
  are responsible for causing inflammation and
  prevent joint damage. Other biologic agents such
  as abatacept (Orencia), rituximab (Rituxan),
  anakinra (Kineret) and tocilizumab (Actemra) work
  to suppress the immune system.
• Corticosteroids. These are steroids generally
  doctors try to avoid using these for young
  children because they can affect the childs
  normal growth when used for longer periods.
  Patients with severe pain and swollen joints
  with other types of JIA, or with oligoarthritis,
  these medicines are very effective when given as
  an injection into the affected joint. Medications
  are rarely given as pills, as they are effective
  but can have serious side effects including
  weakened bones.

Physical Therapies The treatment should be with a
combination of physical therapy. It will help the
child keep their muscles strong and flexible. A
physical therapist will create an exercise
program that is suitable to the childs
condition. The doctor may recommend splints or
any other devices to help maintain normal bone
and joint growth. Some alternative therapies can
be followed such as acupuncture it will help the
child to manage stress and eases pain. It may
lower the use of painkillers and help in
improving flexibility in affected
joints. Surgery In some severe cases, surgery may
be required to improve the position of a
joint. Lifestyle and home remedies
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• Parents can help children learn self-care
  techniques to cure arthritis which includes
• Getting regular exercise as it promotes both
  muscle strength and joint flexibility. The best
  exercise is swimming.
• Applying cold or heat or hot and cold shower to
  fight morning stiffness.
• Some children may gain more weight due to
  medications or some may have poor appetite. So a
  balanced healthy diet is very important.
• Adequate calcium in the diet is a must for the
  child with JIA as they may develop weak bones.

Conclusion Help your child by treating them like
other children at home. Make them understand that
they can overcome the disease. Motivate them in
all sorts of activities