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| {{EH}}
| | __NOTOC__ |
| | | '''For patient information page click [[{{PAGENAME}} (patient information)|here]]''' |
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| '''Associate Editor-In-Chief:''' {{CZ}} | |
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| ==Overview==
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| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
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| | MeshID = D001171 | | | MeshID = D001171 |
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| {{SI}} | | {{Juvenile idiopathic arthritis}} |
| ===[[The Heart in Juvenile Rheumatoid Arthritis|for the heart in Juvenile idiopathic arthritis click here]]=== | | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} |
| | ===[[The Heart in Juvenile Rheumatoid Arthritis|For the heart in Juvenile idiopathic arthritis click here]]=== |
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| [[Juvenile idiopathic arthritis]] (JIA), formerly known as ''juvenile [[rheumatoid arthritis]] (JRA)'',<ref>{{cite journal | author = Ringold S, Burke A, Glass R | title = JAMA patient page. Juvenile idiopathic arthritis. | journal = JAMA | volume = 294 | issue = 13 | pages = 1722 | year = 2005 | id = PMID 16204672}}</ref> is the most common form of persistent [[arthritis]] in children.
| | {{SK}} JIA; juvenile rheumatoid arthritis; JRA; juvenile chronic arthritis; JCA; Still disease, juvenile-onset; arthritis, juvenile chronic; arthritis, juvenile idiopathic; juvenile-onset Still disease; juvenile-onset Stills disease; Still's disease, juvenile-onset |
| | ==[[Juvenile idiopathic arthritis overview|Overview]]== |
| | ==[[Juvenile idiopathic arthritis classification|Classification]]== |
| | ==[[Juvenile idiopathic arthritis pathophysiology|Pathophysiology]]== |
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| JIA is sometimes referred to as ''juvenile chronic arthritis (JCA)'',<ref>Dana D, Erstad S. Juvenile Idiopathic Arthritis. bchealthguide.org. Available at: [http://www.bchealthguide.org/kbase/topic/major/hw104391/descrip.htm http://www.bchealthguide.org/kbase/topic/major/hw104391/descrip.htm]. Accessed on: March 11, 2007.</ref> a term that is not precise as JIA does not encompass all forms of chronic childhood arthritis.
| | ==[[Juvenile idiopathic arthritis causes|Causes]]== |
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| [[Arthritis]] is the [[inflammation]] of the [[synovium]] (the lining tissues) of a joint. | | ==[[Juvenile idiopathic arthritis differential diagnosis|Differentiating Juvenile idiopathic arthritis from other Diseases]]== |
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| JIA is a subset of arthritis seen in childhood, which may be transient and self-limited or chronic. It differs significantly from arthritis commonly seen in adults ([[osteoarthritis]], [[rheumatoid arthritis]]), and other types of arthritis that can present in childhood which are [[chronic disease|chronic condition]]s (e.g. [[psoriatic arthritis]] and [[ankylosing spondylitis]]).
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| ==Symptoms== | | ==[[Juvenile idiopathic arthritis epidemiology and demographics|Epidemiology and Demographics]]== |
| Symptoms of JIA are often non-specific initially, and include lethargy, reduced physical activity, and poor appetite. The first manifestation, particularly in young children, may be limping. Children may also become quite ill, presenting with flu-like syptoms that persist. The cardinal clinical feature is persistent swelling of the affected joint(s), which commonly include the [[knee]], [[ankle]], [[wrist]] and small joints of the hands and feet. Swelling may be difficult to detect clinically, especially for joints such as those of the spine, [[sacroiliac joint]]s, shoulder, hip and jaw, where imaging techniques such as [[medical ultrasonography|ultrasound]] or [[MRI]] are very useful.
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| [[Pain]] is an important feature of JIA, but young children may have difficulty in communicating this symptom. Late effects of arthritis include joint contracture (stiff, bent joint) and joint damage. Children with JIA vary in the degree to which they are affected by particular symptoms. | | ==[[Juvenile idiopathic arthritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Etiology== | | ==Diagnosis== |
| The cause of JIA, as the word ''[[idiopathic]]'' suggests, is unknown and currently an area of active research.<ref>{{cite journal |author=Phelan J, Thompson S |title=Genomic progress in pediatric arthritis: recent work and future goals |journal=Curr Opin Rheumatol |volume=18 |issue=5 |pages=482-9 |year=2006 |pmid=16896287}}</ref> Current understanding of JIA suggests that it arises in a genetically susceptible individual due to environmental factors.<ref>{{cite journal |author=Førre O, Smerdel A |title=Genetic epidemiology of juvenile idiopathic arthritis |journal=Scand J Rheumatol |volume=31 |issue=3 |pages=123-8 |year=2002 |pmid=12195624}}</ref>
| | [[Juvenile idiopathic arthritis history and symptoms|History and Symptoms]] | [[Juvenile idiopathic arthritis physical examination|Physical Examination]] | [[Juvenile idiopathic arthritis laboratory findings|Laboratory Findings]] | [[Juvenile idiopathic arthritis x ray|X Ray]] | [[Juvenile idiopathic arthritis CT|CT]] | [[Juvenile idiopathic arthritis MRI|MRI]] | [[Juvenile idiopathic arthritis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Juvenile idiopathic arthritis other imaging findings|Other Imaging Findings]] | [[Juvenile idiopathic arthritis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Types of JIA==
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| The 3 major types of JIA are oligoarticular JIA, polyarticular JIA and systemic JIA.
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| {{familytree/start}}
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| {{familytree | | | | | | | | | A01 | | | | | |A01=JIA}}
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| {{familytree | | | | |,|-|-|-|-|+|-|-|-|-|.| |}}
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| {{familytree | | | | B01 | | | B02 | | | B03 |B01=Oligoarticular JIA|B02=Polyarticular JIA|B03=Systemic JIA}}
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| {{familytree/end}}
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| ===Oligoarticular (pauciarticular) JIA===
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| Oligoarticular (or pauciarticular) JIA affects 4 or fewer joints. ''Oligo'' means few. It was previously known as pauciarticular JIA. Patients with oligoarticular JIA are more often [[antinuclear antibody|ANA]] positive, when compared to other types of JIA.<ref>{{cite journal | author = | title = Uveitis and Anti Nuclear antibody Positivity in Children with Juvenile Idiopathic Arthritis. | journal = Indian Pediatr | volume = 41 | issue = 10 | pages = 1035-1039 | year = 2004 | id = PMID 15523130}}</ref>
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| ===Polyarticular JIA===
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| Affecting 5 or more joints in the first 6 months of disease. This subtype can include the affect of the neck and jaw as well as the small joints usually affected. This type of JIA is more common in small girls to that of boys.
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| ===Systemic JIA ([[Still's Disease]])===
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| Is characterized by arthritis, [[fever]] and a salmon pink [[rash]]. Systemic JIA can be challenging to diagnose because the fever and rash come and go. It affects males and females equally, unlike the other two subtypes of JIA.
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| Systemic JIA may have [[internal organ]] involvement and lead to [[serositis]] (e.g. [[pericarditis]]).
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| ==Onset==
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| JIA occurs in both [[gender|sexes]]. Symptoms onset is frequently dependent on the subtype of JIA (see Types of JIA) and is from the pre-school years to the early teenage years.
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| ==Prevalence==
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| Juvenile idiopathic arthritis affects an estimated 300,000 children in the United States. Of these children, 50 percent have pauciarticular JIA, 40 percent have polyarticular JIA and 10 percent have systemic JIA. | |
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| ==Extra-articular manifestations==
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| 1. Eye disease: JIA is associated with inflammation in the front of the eye (''chronic anterior uveitis''). This complication may not have any symptoms and can be detected by an experienced ophthalmologist using a slit lamp. Most children with JIA are enrolled in a regular slit lamp screening program, as poorly controlled chronic anterior uveitis may result in permanent eye damage, including blindness.
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| 2. Growth disturbance: Children with JIA may have reduced overall rate of growth, especially if the disease involves many joints or other body systems. Paradoxically, individually affected large joints (such as the knee) may grow faster, due to inflammation - induced, increased blood supply to the bone growth plates situated near the joints
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| ==Treatment== | | ==Treatment== |
| The treatment of JIA is best undertaken by an experienced team of health professionals, including paediatric rheumatologists, nurse specialists, physiotherapists, occupational therapists, chiropractors and psychologists. Many others in the wider health and school communities also have valuable roles to play, such as ophthalmologists, dentists, orthopaedic surgeons, school nurses and teachers, careers advisors and, of course local general practitioners, paediatricians and rheumatologists. It is essential that every effort is made to involve the affected child and their family in disease education and balanced treatment decisions.
| | [[Juvenile idiopathic arthritis medical therapy|Medical Therapy]] | [[Juvenile idiopathic arthritis surgery|Surgery]] | [[Juvenile idiopathic arthritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Juvenile idiopathic arthritis future or investigational therapies|Future or Investigational Therapies]] |
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| There have been very beneficial advances in drug treatment over the last 20 years. Most children are treated with [[non-steroidal anti-inflammatory drug]]s and intra-articular [[corticosteroid]] injections. [[Methotrexate]] is a powerful drug which helps suppress joint inflammation in the majority of JIA patients with polyarthritis and systemic arthritis. Newer drugs have been developed recently, such as TNF alpha blockers, which appear to be effective in severe JIA. There is little or no controlled evidence to support the use of alternative remedies such as specific dietary exclusions, homeopathic treatment or acupuncture.
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| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | :[[Juvenile idiopathic arthritis case study one|Case #1]] |
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| ==External links== | | ==External links== |
| [http://www.arthritis.org/juvenile-arthritis.php Juvenile Arthritis Alliance]
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| [http://www.nlm.nih.gov/medlineplus/juvenilerheumatoidarthritis.html Juvenile Idiopathic Arthritis NIH Medline Plus] | | [http://www.nlm.nih.gov/medlineplus/juvenilerheumatoidarthritis.html Juvenile Idiopathic Arthritis NIH Medline Plus] |
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| [http://www.arthritis-treatment-guide.info/news/arthritis-types/juvenile/juvenile-rheumatoid-arthritis/ Juvenile Arthritis Treatment Guide]
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| {{SIB}}
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
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