Arthritis in children

Also known as juvenile idiopathic arthritis and juvenile chronic arthritis

Arthritis in children is an autoimmune illness where, for unknown reasons, the immune system becomes confused and attacks healthy cells rather than invading foreign bodies such as bacteria or viruses.

It is commonly diagnosed between ages 1 and 4 years, but can occur at any age.

Key points

  1. About one in 1000 children has arthritis in their early years.
  2. There are many different types of arthritis. Your child's symptoms and treatment will depend on which type they have.
  3. Many children will be free of arthritis symptoms before adulthood, while others will still need treatment as adults.
  4. Treatment and good management offer a positive outlook for many children with arthritis, though some children may have longer term problems.
  5. A rheumatologist will guide you and your child through your treatment options.

Causes

The cells in the body that the immune system attacks, are in the connective tissues that make up the lining of the joints (synovium). As these types of cells also exist outside of the joints, arthritis can affect other parts of the body as well. Some possible causes of the disease include:

  • Genetics: Research suggests that for some types of JIA, genetics may be involved. However, these conditions are not regarded as hereditary. So if you have one child with arthritis, it does not mean your other children will also have arthritis. It also does not mean that your child’s children will develop JIA.
  • Infection: Another theory is that some form of infection may trigger the start of JIA. However, JIA cannot be spread from child to another; it is not infectious.
  • Dietary and emotional factors do not appear to play a role in the development of JIA.

Diagnosis

There is no single test to diagnose juvenile idiopathic arthritis (JIA). Instead, it involves a number of steps. These include:

  • Taking a detailed medical history of the child and their biologically related family members (where possible).
  • Physical examinations.
  • Laboratory tests (eg, blood and urine).
  • Other tests such as x-rays of the joints.

Some tests may be ongoing or have to be repeated several times. This helps the doctor to look for changes in your child’s symptoms over a time period. If JIA is suspected, your child should be referred to a rheumatologist, ideally a specialist in paediatric (childhood) arthritis, who would confirm the diagnosis and then start treatment.

Reaching a diagnosis can take time, and the waiting period can be very frustrating. This is understandable, but it's important to keep on with the process until the diagnosis is made. The rheumatologist can then make sure your child receives the best treatment to manage the symptoms and reduce the potential damage caused by JIA.

At some point, your child will be asked to have a number of tests as part of the diagnosis or management of the arthritis. There is nothing to be alarmed about, these are routine. Some of the more common tests include:

  • FBC (full blood count) – a blood test to check for anything abnormal that might be important in managing the illness
  • RF (rheumatoid factor) – an antibody detected by blood test. This is an indicator of the kind of JIA your child has
  • ESR (erythrocyte sedimentation rate) – a blood test that detects how much inflammation there is in the body
  • CRP (C-reactive protein) – also a test that detects inflammation
  • ANA (anti-nuclear antibody) – this test is used to do two things: it helps identify the type of arthritis your child has; and, it is an important indicator of your child’s risk of developing eye problems
  • X-ray – takes pictures of your child’s joints to see how they change with time
  • MRI or CT scans (magnetic resonance imaging or computed tomography) – they do much the same as x-ray but in greater detail. They can also show changes in non-bone structures around the joints (like ligaments and tendons)
  • HLA-B27 – a blood test that helps determine the type of arthritis your child may have.

Is JIA curable?

The outlook for children with JIA is usually very positive:

  • Most children with JIA will not have active symptoms by the time they become adults.
  • With appropriate management, most children with JIA will grow up without any lasting effects of their arthritis.

There is no way to predict which outcome your child will have. Some forms of JIA have a greater chance of permanent remission (where the condition will not return). Your child’s rheumatologist can give you more information about this.

Good medical care is vital for all children with any form of JIA. Good overall care, both during and between flares:

  • can minimise the effects of illness
  • helps keep lives as ‘normal’ as possible, now and in the future.

Possible complications of arthritis

Frozen joints

Arthritis-affected joints that are not kept mobile can stiffen into abnormal positions and then will no longer work properly. This can also lead to joint damage and severely restrict your child’s ability to do most normal daily activities for the rest of their life.

A small number of children with JIA may need to have surgery if the damage to their joints becomes too severe or restrictive. This may include joint replacements, joint fusions, the realignment or reconstruction of damaged joints and surgery to release joints that have ‘frozen’. Your child’s rheumatologist can give you more information.

Osteoporosis

Children who have JIA are also more likely to experience a thinning of their bones as they get older. This is a condition called osteoporosis and it results in the bones being susceptible to breaking or fracturing.

Learn more

Arthritis New Zealand 
Kids with arthritis New Zealand 
Arthritis information

Credits: Arthritis New Zealand. Edited by Health Navigator, November 2013. Image credits 123rf.com. Reviewed By: Editorial team Last reviewed: 19 Mar 2015