Juvenile idiopathic 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.
- 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.
- 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.
- 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
- 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).
- 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.
- 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).
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