Juvenile idiopathic arthritis

Juvenile idiopathic arthritis: Description, Causes and Risk Factors:Abbreviation: JIA.Juvenile idiopathic arthritisArthritis is an inflammation of the joints, with pain or stiffness. It may be acute or chronic. Acute arthritis is also called septic arthritis and may affect one or more joints. Juvenile idiopathic arthritis is an umbrella term referring to a group of disorders characterized by chronic arthritis. JIA is an autoimmune disease, which is defined by the presence of arthritis for at least six weeks in a child less than 17 years of age.Based on the ACR (American College of Rheumatology) criteria, between 2 and 20 of every 100,000 children develop JIA each year. The overall prevalence is approximately 16 to 150 per 100,000.There are three types of JIA, which are diagnosed according to symptoms and blood tests.Oligoarticular Juvenile Idiopathic Arthritis: the most common kind of childhood arthritis, which often starts at the age of two or three. The problem is limited to four joints or fewer, which become swollen and painful. Sometimes the eyes are affected, too. It is also known as pauciarticular arthritis.
  • Polyarticular Juvenile Idiopathic Arthritis: affects five or more joints. It can start at any age, from a few months onwards, and usually spreads quite quickly from one joint to another. Children often feel generally unwell, sometimes with a fever.
  • Systemic Onset Juvenile Idiopathic Arthritis: affects the whole body, and causes fever and rashes as well as inflamed and painful joints. It usually starts in children under five but can affect children of any age. It used to be called Still's disease.
Causes and Risk Factors:Infection is an important but treatable cause of juvenile idiopathic arthritis, especially in the under-twos. Infections include bacteria and viruses, such as mumps, rubella, herpes and Lyme disease.
  • Polyarticular juvenile idiopathic arthritis may be caused by many different things including inflammatory bowel disease, such as Crohn's disease, inflammatory blood vessel disease or vasculitis, blood disorders such as sickle cell anaemia (SCA) or hemophilia, malignancy, cystic fibrosis and connective tissue disorders often because of problems linked to the immune system, such as lupus and ankylosing spondylitis.
  • The cause of systemic juvenile idiopathic arthritis is unknown. Genetic factors may play a part and disease may be triggered by a viral infection (although none has been identified), which causes overactivity of the immune system.
  • Several studies have implicated rubella and parvovirus B19 as possible causes of JIA because rubella virus persists in lymphocytes and establishes a focus of persistent infection in the synovium resulting in chronic inflammation. These data have been difficult to replicate in other laboratories, however. Highly conserved bacterial heat shock proteins may be potential disease triggers.
Possible risk factors may include:Disordered Th1/Th2 interaction.
  • Abnormal T-cell receptor polymorphism.
  • Immune complex formation, complement activation and consumption, presence of autoantibodies and characteristics cytokines profiles:
    • IL-6 (interleukin-6), IL-1 (interleukin-1), TNF-) (tumor necrosis factor-alpha): Systemic onset JIA.
    • IL-1) (interleukin-1 alpha), IL-1 (interleukin-1 beta), sIL-2R (soluble interleukin-2 receptor): Polyarticular course.
    • sIL-2R, IL-1, TNF-) Oligoarticular JIA.
Symptoms:The most common symptoms of all forms of JIA include:Joint pain and swelling that may come and go but are most often persistent.
  • Joint stiffness in the morning.
  • Irritability, refusal to walk, or protection or guarding of a joint. You might notice your child limping or trying not to use a certain joint.
  • Often unpredictable changes in symptoms, from periods with no symptoms (remission) to flare-ups.
  • Additional symptoms vary depending on which type of JIA a child has.
  • Rash caused by systemic JIA is spotty, flat, and sometimes faint red or pink and may occur with the fever
Diagnosis:Diagnosis is made on the basis of a combination of clinical examination, x-rays, bone scans and blood tests. It may be necessary to take a sample of fluid from the joint to test for infectious organisms.The following tests are done if needed:Rheumatoid factor (RF), to clarify whether a child with polyarticular JIA is RF-positive or RF-negative.
  • Antinuclear antibody (ANA) to clarify a child's type of JIA and risk for eye disease (a positive ANA result is a marker for high eye disease risk, usually found in girls who develop oligoarticular JIA at a young age).
  • X-ray.
  • Magnetic resonance imaging (MRI), which may reveal early joint damage.
  • Human lymphocyte antigen or HLA-B27 genetic test, which may help distinguish JIA from other types of arthritis that affect children, such as ankylosing spondylitis.
Treatment:Treatments include drugs to control pain and inflammation, steroids (in more severe cases, which may include injections into the joint) and powerful medicines that alter the immune system (such as methotrexate, Salazopyrin, cyclosporine and etanercept).Unless your child's condition is life-threatening or involves severe eye or joint inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are likely to be the first line of medication treatment to reduce inflammation and any pain. If you see no improvement after 6 weeks, your doctor may try a different NSAID. Some children gain relief from one NSAID but not another.
  • In cases of severe JIA, your doctor may prescribe medicines referred to as disease-modifying antirheumatic drugs (DMARDs). Methotrexate, either alone or in combination with other medicines, is the DMARD that is usually tried first. A type of DMARD called a biologic, such as etanercept (Enbrel), may also be tried.
  • A corticosteroid injection into a joint also may be used to reduce inflammation, particularly if your child has oligoarticular JIA (formerly known as pauciarticular JIA).
Physiotherapy to keep the joints mobile and build muscle strength is also important. Splinting or surgery is sometimes needed.Physical therapy is a vital component of the successful ongoing management of JIA. Help your child understand the importance of physical therapy exercises and help him or her keep an upbeat attitude about twice-or-more daily stretching and strengthening sessions. Working closely with a pediatric physical therapist can be especially helpful.Occupational therapy is often recommended. An occupational therapist (OT) can help a child learn ways to do self-care activities, play, and participate in school without making their symptoms worse.In most cases, children recover from JIA with few long-term problems. However, some do experience considerable difficulties from ongoing disease or damaged joints throughout adolescence and into adulthood.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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