It is commonly believed that arthritis primarily affects the elderly. However, this is not true. Arthritis can also affect children. Juvenile rheumatoid arthritis (JRA), often referred to as Juvenile idiopathic arthritis (JIA), is a type of arthritis that affects children aged 16 or younger. It causes swelling, redness, warmth, and soreness in joints. A study by Paediatric Rheumatology Online Journal states that Juvenile idiopathic arthritis may affect 1 in 10,000 children. Juvenile idiopathic arthritis is an auto-immune disease that means our body identifies some of its cells as foreign. The immune system, which is generally responsible for fighting off harmful foreign substances such as bacteria or viruses, begins to target and attack healthy cells and tissues.

What is Juvenile idiopathic arthritis?

 Juvenile idiopathic arthritis is an auto-immune and inflammatory condition that occurs in children. The exact cause of this is still unknown, but genetic and environmental factors such as viruses such as 

• Epstein-barr virus (EBV) 
• Rubella Virus
• Enteroviruses

In children, arthritis affects joints, skin, gastrointestinal tract, and eyes. In this condition, the stiffness of bones lasts at least six weeks.

Symptoms of Juvenile idiopathic arthritis?

Symptoms of juvenile arthritis change over time. Symptoms may worsen, called flares, or they can improve, called remission. The following are the symptoms of 

•      Pain and discomfort in joints
•     Symptoms include eye inflammation and redness, as well as exhaustion.
•   Swelling and stiffness in joints
•    Loss of appetite
•    Blurry eyesight
•    Fever
•    Skin rashes
•    Loss of weight
•    Difficulty completing basic tasks like walking and dressing.
•    Redness and feeling of warmth in joints.
•     Slows down growth and poor appetite.
•     The feeling of tiredness and fatigue.

How is Juvenile idiopathic arthritis diagnosed?

To diagnose juvenile idiopathic arthritis, the doctor may ask for the following:

• Proper medical and family history of the child as it is an auto-immune disease.
• The doctor may also check the motion and movements of the joints.

Other than this, there are some tests that are commonly performed to diagnose juvenile idiopathic arthritis:

 Blood tests that are performed when the juvenile idiopathic arthritis is suspected:

•  Erythrocyte sedimentation rate (ESR)
• Rheumatoid factor
•  C-reactive protein
• Cyclic citrullinated peptide (CCP)
•  Antinuclear antibody

The child may also undergo imaging testing. These can indicate the extent of bone damage. Tests may include:

•   X-rays
•   MRI
•   Bone scan
•   CT scan

What are the different types of Juvenile idiopathic arthritis?

There are many types of Juvenile idiopathic arthritis (JRA):

•   Oligoarticular JIA: This is the most common type of JRA that affects five or fewer joints throughout the first six months. This generally affects large joints such as knees, ankles and elbows. The symptoms may include joint pain, swelling, and stiffness.

• Systemic onset JIA: This is the least common type of JRA found in 1 in 10 children, which may affect one or more joints in children and may cause inflammation in the internal organs such as the heart, spleen, liver, and lymph nodes. Children can also experience high-grade fever and skin rash.

• Polyarticular JIA: This type of JRA will affect five or more joints in the first 6 months of the disease. It is categorised into polyarthritis rheumatoid factor positive and polyarthritis rheumatoid factor negative based on the presence or absence of the rheumatoid factor.

•   Enthesitis-related JIA: Children may have inflammation where ligaments and tendons connect to the bone known as enthesis. This usually affects the spine, hips, knees and feet. 

•   Psoriatic JIA: In this case, the child will be affected with arthritis associated with psoriasis ( a skin condition). This condition usually affects fingers, toes, wrist knees and ankles. The children may also develop skin rashes and nail changes.

•   Undifferentiated JIA: This is a case where the child develops two or more types of JRA, as listed above.

Will Juvenile idiopathic arthritis worsen or spread:

This is definitely one of the most often-asked questions. Unfortunately, doctors cannot properly predict how the disease will proceed or provide a solid treatment plan. A few children will only have one affected joint for the duration of their JIA. Other children will begin with one joint and progress to impact more joints or even huge and small joints. In some cases, the condition is modest and easily controlled. In some patients, it is more severe and harder to manage.

Complications in Juvenile idiopathic arthritis:

If not treated, Juvenile idiopathic arthritis can lead to severe complications such as:

•        Permanent damage to the joints.
•        It may affect a child's growth and bone strength.
•        Chronic arthritis and disability (loss of function).
•        Vision problems such as blurry vision. 

 However, appropriate treatment might help to ease pain, prevent long-term bone damage, and keep children active. Some tips to overcome the complication mentioned above:

•    Seeking proper medical advice may reduce the risk of developing the above-mentioned complication.
•   Juvenile idiopathic arthritis may increase the risk of eye-related problems, such as eye inflammation, which is known as uveitis. If not treated, this may also lead to cataracts and blindness.
•   Stick to the proper treatment plan to manage the symptoms.
•   Get proper advice from the physical therapist and develop a standard exercise plan which will make their child’s muscles flexible and stronger.

Treatment plan for Juvenile idiopathic arthritis:

The primary goal of treating juvenile idiopathic arthritis is to help children maintain a normal level of physical and social activity. To achieve this goal, rheumatologists frequently combine several therapy choices to relieve pain, manage swelling, prevent joint mobility and strength, and prevent problems. Some therapeutic options are:

Medication management that is considered are:

•       Nonsteroidal anti-inflammatory drugs (NSAIDs): This medicine is mainly used for three purposes:

1.     To treat inflammation (Anti-inflammatory)
2.     To provide fever relief (Analgesic)
3.     Pain management (Antipyretic)

Some commonly prescribed NSAIDSs are ibuprofen and naproxen.

•       Disease-modifying antirheumatic drugs (DMARDs): Commonly prescribed when the NSAIDs fail to achieve the expected outcome. It is used to prevent high damage in the future.
•       Biologic agents: These are prescribed to block a very important step in the inflammation process. This medication is also considered  one of the most effective ways of controlling JIA. Some of the commonly used injectables are Actemra 400mg Injection 

•       Corticosteroids: Commonly prescribed steroids such as prednisone can be used to decrease symptoms such as inflammation. This drug should be used only for a short duration as it may affect a child's growth. 

Supportive therapies:

 Physical therapy should also be considered, as it helps keep a child's muscles strong and flexible. A physiatrist or a physical therapist will create a standard exercise plan for the children and may also use a splint (which is used to support joints and make healing faster) for bone growth and joint support.

 What are the Lifestyle modification and home remedies:

Some lifestyle modifications and home remedies can really help people cope with juvenile rheumatoid arthritis. Here are things to know:

•       Cold or heat application: Children with juvenile rheumatoid arthritis may experience stiffness of joints, especially during the morning time. Depending on their convenience, hot or cold packs can be applied.
•       Regular exercise and therapy: Children with rheumatoid arthritis should actively engage in physical activity as advised by the physical therapist. Physical activity can improve their muscle strength and muscle endurance, which aids in supporting the joints.
•       Nutrition: Taking nutrition-rich food is essential for all growing children. But for children who are affected with juvenile idiopathic arthritis, it is essential to have nutrition-rich food such as:

•   Omega-3-Rich Food
•   Clean Protein
•   Calcium and D-Rich Foods
•   Colourful Fruits and Veggies
•   Fibre-Rich Foods

Food that should be avoided in juvenile idiopathic arthritis:

• High sugar content
•  Saturated and Trans Fats
•   Highly processed food