J U V E N I L E I D I O P A T H I C
A R T H R I T I S
( J I A )
It is inflammation (swelling) of one or more of your joints. It first occurs before your 16th birthday.
JIA is slightly more common in girls. It most commonly occurs in pre-school age children or teenagers. There are different types of JIA and symptoms vary between the different types. JIA may be difficult to control in some people, but most cases will be well controlled with treatment most of the time. If you have arthritis as part of another condition, it's often managed in a very similar way to JIA.
We don't completely understand what causes JIA. In fact,
that's what ‘idiopathic’ means. JIA is an autoimmune disease. Your immune
system is your body’s way of defending itself against injury, illness or
bacteria. Your body can defend itself by causing inflammation or swelling. But
when you have JIA, your body creates inflammation in a joint or joints when it
doesn’t need to. This inflammation then causes stiffness and pain. JIA is
thought to be due to a combination of genetic factors and trigger factors from
the environment, for example the infections that your immune system has been in
touch with. There’s no evidence that a specific infection causes JIA, but an
infection may trigger your immune system's response that then carries on and
affects your joints.
You'll be diagnosed with JIA if...
You've had arthritis for
six weeks or more; your symptoms started before your 16th birthday; your doctor
has ruled out other conditions that can cause arthritis.
Flare-ups of JIA (where symptoms get worse) can happen
after: infections, periods of stress, changes in medication. But they can often
happen for no apparent reason. Flare-ups can: reduce your appetite, reduce
energy levels, and cause joint pain, swelling and stiffness. Sometimes you'll
be able to manage the symptoms with a non-steroidal anti-inflammatory drug
(NSAID) such as ibuprofen for a few days or weeks. But if your symptoms are
troubling you or they carry on you should contact your rheumatology team.
Stiff joints; your joints may feel stiffer after resting,
for example first thing in the morning. To help with stiffness you should do
some gentle activity. Swimming can be very good, especially in a warm pool. You
might need to adapt this if you're having a flare-up.
Mood; JIA can affect sleep patterns. You may also feel fed
up as a consequence of joint pains, frustrated at not being able to do
everything you want to, or due to difficulties with medication. It's very
important to share these concerns with the paediatric/adolescent rheumatology
team.
Eye inflammation; between 10 and 20% of people with JIA will
develop a potentially serious inflammatory eye condition called uveitis. As
many as half of young people who develop uveitis could develop complications,
such as cateracts or glaucoma, or need eye surgery. If it's left untreated,
uveitis can potentially lead to sight loss. Uveitis can cause pain and redness
in the eyes, but it can also develop without any noticeable symptoms. The type
most associated with JIA, chronic anterior uveitis, doesn't cause any pain or
redness. It's important to be screened by an eye specialist (opthalmologist) so
that it doesn't go undetected. They'll check your sight and then carry out an
exam with a bright light. The exam is painless. The treatment for uveitis is
initially steroid drops. Drugs called methotrexate, tocilizumab and adalimumab
can also be prescribed. Arthritis Research UK is funding studies which are
looking at the effectiveness of these drugs in treating uveitis.
Puberty; JIA probably won't affect puberty, but sometimes
arthritis or some medications (for example steroids) can make the changes of
puberty happen later. In girls, periods can become irregular if arthritis is
very active. Some of the medications, such as methotrexate, can have the same
effect. If you're worried about how you look or about changes happening to your
body, discussing this with your family, friends, your school nurse or
rheumatology team can be helpful.
Growth; JIA probably won’t affect your growth, but sometimes
having severe arthritis and/or being on steroid tablets can slow growth. If
your growth is slower than normal for a time, it can often catch up later,
especially when arthritis is well controlled. If active arthritis is left
untreated in a joint, the growth of that joint can be affected. It’s important
to get control of the arthritis before that happens.
Teeth; you may have trouble with your teeth if you have
difficulty brushing, but also because of effects of medications. It's important
to have regular dental check-ups. You may need orthodontic advice if arthritis
has affected your jaw. You might find that an electric toothbrush is helpful.
They can do some of the work for you to help make sure you clean your teeth
thoroughly. If possible, ask for sugar-free drugs. If you take medications by
mouth, brushing your teeth after is a good idea.
The aim of treatment for juvenile idiopathic arthritis (JIA)
is to:
- · Control the symptoms of arthritis
- · Enable you to lead an active life at school or college
- · Enable you to enjoy an active family and social life
- · Help you become an independent adult.
It’s important to do all of these things but at the same
time try to reduce any side-effects caused by the medicines.
Drugs for JIA; drugs can’t cure arthritis, but they can
control the symptoms and help to reduce the possibility of joint damage. An
increasing number of medicines are now available.
Painkillers (analgesics); these drugs help to control the
pain of arthritis. Common painkillers include paracetamol, codeine or
combinations e.g. co-codamol. They have to be taken regularly for maximum
effect, which lasts hours not days. Side-effects include constipation,
drowsiness and feeling a bit spaced-out.
Non-steroidal anti-inflammatory drugs (NSAIDs); these often
help to reduce pain, stiffness and swelling. Examples of the many NSAIDs
include ibuprofen, piroxicam, naproxen and diclofenac. These have to be taken
regularly to get maximum effect, which lasts hours not days. Side-effects
include indigestion and other stomach problems. The risk of this happening can
be reduced by always taking them with food. You should tell your doctor or
rheumatology nurse specialist if you develop any stomach pains or cramps.
Disease-modifying anti-rheumatic drugs (DMARDs); these drugs
dampen down inflammation and can reduce the joint damage caused by arthritis. Methotrexate
is the most commonly used DMARD in JIA. It can be given as a weekly dose by
mouth or injection. Side-effects of methotrexate are rare, but you’ll need
regular blood tests to check for them. These drugs are slow to become effective
and you may not notice any benefit for several months.
Biological therapies; biological therapies is a name given
to some newer drugs that have been available for about 10 years. Just like
DMARDs, they slow down the progress of arthritis and reduce pain, swelling and
stiffness. Like DMARDs they work by suppressing the immune system, and they’re
called biological therapies because they were developed from research into the
biology of arthritis. These drugs are used if you don’t respond to DMARDs such
as methotrexate.
The main biological therapy used for JIA is etanercept, but
others such as infliximab and adalimumab are now becoming more available for
children and young people with the condition.
Steroids; these drugs control inflammation, pain and
stiffness. They can be given as tablets, by injection into a joint or by a drip
into a vein. A common treatment for young people is a steroid injection into
the affected joint. Injections are very effective for many months, are very
well tolerated and cause very few side-effects. In younger children these
injections will be done under general anaesthetic, but as you get older these
may be done under sedation, with gas and air (entonox) or awake with a local
anaesthetic. In adult clinics, joint injections are always given with a local
anaesthetic when you’re awake. Steroid tablets are used less for young people
than steroid injections. Side-effects are more common with large doses and
longer courses (over weeks and months). Short courses (for a few days or up to
a week) or low doses tend to have few or no side-effects. Steroids should never
be stopped suddenly (except if you’ve only been on them for under 2 weeks) as
you can become very ill.
Eye drops; These will be used if you have eye inflammation.
They’re used to reduce the inflammation, prevent the swollen iris from sticking
to the lens and to reduce pressure inside the eye. Some of the medicines used
for the arthritis, such as methotrexate and the biological therapies, can be
used to treat eye inflammation if the eye drops alone aren’t enough.
Key points about drug treatments…
The risk of chickenpox – Chickenpox can be more severe if
you’re taking steroids, methotrexate or biological therapies. If you haven’t
had chickenpox (or aren’t sure) then tell your doctor or rheumatology nurse.
They’ll give you advice on what to do if you get chickenpox or have been around
someone with the condition. You may be able to have a vaccine.
Avoid certain vaccines – You must not have certain vaccines
(live vaccines) if you’re taking methotrexate or biological therapies. These
include vaccines against rubella (German measles) and BCG for tuberculosis
(TB). However, most other vaccines are well tolerated and effective and it’s a
good idea to have them. Check with your nurse or doctor.
Avoid drinking alcohol – Alcohol makes your liver more
sensitive to the effect of methotrexate, which increases the risk of liver
damage. You may be advised not to drink alcohol at all, but in truth many young
people do drink some alcohol without apparent side-effects with their liver.
Use reliable contraception – If you’re taking drugs like
methotrexate and are sexually active, it’s important that you use effective
contraception. This drug can damage sperm in a man and eggs in a woman and may
cause serious harm to the developing baby. If you want to have a baby or become
a father in the future then methotrexate must be stopped at least 3 months
beforehand. Discuss this with your doctor or nurse. If you do have unprotected
sex then you should seek advice urgently from your nurse, GP or local sexual
health clinic.
Physiotherapy and occupational therapy can:
- · Help your arthritis.
- · Relieve pain.
- · Improve your ability to get on with life.
- · Provide exercises to stretch soft tissues and build up muscles.
- · Improve your heart and lung fitness.
Your physiotherapist and occupational therapist will assess
you and will develop a programme for your individual needs so that you’re able
to do the activities you want and need to be able to do in your daily life.
They may give you exercises and coping strategies and sometimes they may
provide equipment to make daily activities easier.
Pain relief; there are various ways to relieve pain, such as
hot and cold pads, TENS, acupuncture, massage, hydrotherapy and relaxation. If
your sleep is affected, it’s good to have a regular routine and some method of
pain relief before bed.
Exercise; physiotherapists will help you with daily exercise
by giving you a plan to follow that suits your needs. Your exercise plan will
aim to make your muscles stronger and more flexible, which may help prevent
damage to your joints and improve your movement. If you have a flare-up or a
specific joint problem your physiotherapist will help you to improve or regain
your strength.
Posture; A good upright posture is important to keep your
body working efficiently. This means keeping the muscles strong enough to keep
the back straight, with the shoulders relaxed but held back and the head up.
This is particularly important when you’re sitting using a computer. Your
therapists can give you tips to improve your posture and exercises to
strengthen the ‘core’ of your body (the muscles of your stomach and back).
Splints and insoles; splints will help stabilise your joints
and give support to allow you to keep going for longer periods. A podiatrist
will be able to provide you with insoles, which will give added support to your
feet and ankles and can often help to relieve pain in your knees and hips.
Protecting your joints; it’s important to be aware of joint
protection. The muscles and soft tissues which hold your joints in place can be
put under strain as you use them. Use supports for the joints if necessary and
ensure that your muscles are as strong as possible.
Body beautiful; your therapists can provide equipment to
help with your daily routine of washing and getting ready. An occupational
therapist can give advice and provide equipment to help you be independent –
for example, an aid to get in and out of the bath, if necessary.
Mobility; most young people with JIA have normal mobility.
However, you may need to allow extra time to get from place to place,
especially if you have to use stairs. You may need crutches to help with
walking, or a wheelchair if walking distances becomes a problem. Your therapy
team will advise you on what mobility aids you may need and give you tips for
getting about. A wheelchair is an aid to your mobility, not a replacement for
it.
Surgery; Some young people with severe arthritis will benefit from
surgery when other treatments haven’t helped. However, such procedures are now
much rarer due to the more effective drug therapies available.
Please note that the information on our (Arthritis Research
UK) drugs pages has been written for adult use and may be different for young
people. Speak to your rheumatologist for more specific information about medication
and young people.
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