Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and affects about one in 1,000 children. It is a chronic autoimmune disease which does not go away because it is a result of the person’s own immune system.
An autoimmune disease is one in which white blood cells cannot tell the difference between the body’s own healthy cells and germs like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.
“Each year more than 1,000 patients are treated in our rheumatology clinic,” said Dr. Melissa Mannion, pediatric rheumatologist at Children’s of Alabama. “It is our goal to provide patients with resources and treatments to develop growth and development.”
Dr. Melissa Mannion
Signs and Symptoms
The first signs of arthritis can be subtle or obvious, so an early and accurate diagnosis is key to effectively managing JIA. According to Dr. Mannion, the criteria for diagnosis includes age less than 16 at the onset of symptoms, symptoms present for at least six weeks, symptoms including the presence of arthritis on exam, and no other explanation for the arthritis-like cancer or infection.
Understanding the symptoms and characteristics of each type of JIA is crucial. Some of the common symptoms include:
- Warm joints
- Sore wrist, finger or knee
- Sudden swelling of joins that remain enlarged
- Stiffness in the neck, hips or other joints
“If someone’s disease stays inactive for a long time, usually at least six months, they are said to be in remission,” she said. “Remission means that the disease is quiet, but the disease itself is not gone since there is no cure. Sometimes remission can last for months, years or a person’s lifetime.”
If a parent is worried that their child has arthritis they should talk to their pediatrician. The pediatrician will evaluate the duration of the symptoms, what hurts, when it hurts, where the swelling occurs, how long it lasts, what makes the pain or swelling better or worse, and if there are any other symptoms like fever or rashes. They will also help determine if your child needs to see a rheumatologist.
To diagnose JIA, the rheumatologist will ask questions about the child’s symptoms, find out whether other family members have had similar problems, and do a thorough physical examination.
It is important that the doctor identifies any additional signs or symptoms to classify or describe the type of JIA, as there are multiple. In some cases, the doctor will use imaging, like musculoskeletal ultrasound or MRI, to look for inflammation inside the joints. The doctor may also order X-rays or blood tests to rule out other conditions or infections, such as Lyme disease, that may cause similar symptoms or occur along with the arthritis.
The health care providers, including the primary care physician, rheumatologist, and physical therapist, will work together to develop the best method of treatment for each child.
“Medications are used to control the immune system to stop the symptoms and prevent damage from the disease,” she said. “Some patients can be treated with a steroid injection into the joint, but because the immune system is not only located in one joint most patients will need systemic medications to control their disease.”
The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development.
Children’s division consists of five board-certified pediatric rheumatologists, one pediatric rheumatology fellow (in-training), and three nurse practitioners who see patients with the faculty members. Patients can be seen at the Children’s of Alabama main campus, Children’s South on Acton Road, and in satellite clinics in Huntsville, Montgomery, and Mobile.
For more information, visit childrensal.org/rheumatology.