This is the most common Childhood Rheumatic Disease and one of the most common chronic diseases in children. Every child with joint pain does not have JIA and every child with JIA may not present with joint pain. Please note the term Juvenile Idiopathic Arthritis as opposed to Juvenile Rheumatoid Arthritis which gives the false idea of a young person's version of Rheumatoid Arthritis.

What is Juvenile Idiopathic Arthritis (JIA)?

JIA is a clinical diagnosis. However, we need to consider many possibilities in a child with joint pain from sinister conditions like leukaemia to possible functional pain secondary to unrelated issues like difficult family dynamics, learning difficulties etc. Each diagnosis would require a different approach to management. It is a careful detailed history and evaluation by trained medical personnel that can help to tease out the actual cause.

Symptoms of Juvenile Idiopathic Arthritis

This means that in some cases, making a diagnosis can be challenging and will require a lot of investigation while in others it can be very straightforward. JIA can present quite differently in different children. In some, it could be a silent inflammation of the eyes called uveitis that is the most significant issue and inadequate care can lead to visual loss and complications.

In some, it can present with prolonged fever, a kind of fever that has the potential to make the child very ill, with a complication that can cause death if not managed aggressively.

With involvement of the spine and surrounding joints requires fairly long-standing expensive therapy to prevent long-term disability.

What Is the Nature of Treatment for JIA?

• Medicines

  These medicines come under the immunosuppressive or immunomodulant category. We now have very long periods of observation on children on these medications and we know that the majority tolerate it very well without any significant side effects. We do not recommend the use of long-term steroids in the management (short-term for a few months may be used) as that can compromise growth and bone health in a growing skeleton in addition to other unpopular cosmetic issues.

• DMARDs - Disease Modifying Antirheumatic Drugs

  Disease Modifying Antirheumatic Drugs In a majority of children, DMARDs - Disease Modifying Antirheumatic Drugs (commonest of which is a drug called Methotrexate) are effective, especially if started early, singly or in combination. DMARD therapy is extremely cheap.

• Biological Medications

  However, about a fourth to a third will require biological medications which are quite expensive. Sadly, our population is in the majority not covered by insurance schemes, so the majority are out-of-pocket spenders which becomes very challenging. 

  One of my patients currently requires a biological medication called Anakinra which has to be imported from abroad costing the family a significant sum which they are unable to afford and we are trying charitable support from all quarters. He is an extremely intelligent otherwise thriving toddler with Systemic Onset JIA whose disease is extremely responsive only to this drug.

• Long Term Management

  If not treated early and with the right amount of aggression, JIA can cause considerable long-term disability and very occasionally, death. Treatment is long-term. Most children will not require lifelong therapy. Many children can stop therapy successfully in 2-4 years, but there will be some children needing to continue therapy into adulthood. Long-term therapy does not indicate a lack of treatment, failure of the treating physician or incapacity towards a good quality of life. Even up to 2 decades ago, our clinics featured very highly disabled wheelchair-bound children, but with better protocols and therapies these children look no different nor less able than their peers.

  How Amrita Hospital Supports Children with Juvenile Idiopathic Arthritis (JIA)

  Children with JIA need access to appropriately trained professionals towards an early and right diagnosis. Towards early and appropriate treatment which is monitored correctly.

  Treatment is multidisciplinary, while the Rheumatologist is the fulcrum, Ophthalmology, Paediatricians, Orthopaedic surgeon, Physical Medicine, Occupational therapy and trained nurses are all very significant partners in care.