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What is juvenile idiopathic arthritis?

Juvenile idiopathic arthritis (JIA) 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. Knowing which type you have helps assess the likelihood you''s often managed in a very similar way to JIA.

What should I look out for?

If you have any of these symptoms for more than a couple of weeks, you should see a doctor:

  • painful, swollen or stiff joint(s)
  • joint(s) that are warm to touch
  • increased tiredness
  • a fever that keeps returning
  • a limp but no injury.

If you think that you or someone you know may have JIA, book a GP appointment as soon as possible. Tell them your symptoms and concerns. They''t completely understand what causes JIA. In fact, that''is-jia-genetic-''s very rare to have two people in the same family with JIA, but we do know that genetic factors are involved. This is to do with the genes that are passed down from your parents.

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 often mild. Most commonly affects one or both knees.

Most likely type to cause eye inflammation (chronic anterior uveitis) – you''s the painless type that doesn''ll affect you but usually the fever and rash will settle, although the arthritis may continue for several years before settling. Lots of tests may be needed to confirm the diagnosis and this can be a worrying time.

How will JIA affect me?

Many children who have JIA won''re adults, but it’s not possible to accurately predict this. In most cases, childhood arthritis has a good outcome. You should look forward to a future that’s no different from those of your friends and classmates.

In at least 30% of cases, however, arthritis can remain active into adult life. Some young adults with JIA have joint damage that limits their daily activities to some extent and a few may need joint replacements. Other problems can sometimes occur. Some people are physically smaller than average or have osteoporosis as a result of their arthritis and/or treatment with steroids.

A successful outcome in JIA requires many things, including:

  • a positive approach
  • an experienced team working alongside your GP
  • a caring, helpful environment with support from family, friends and teachers.

You also need to know how to get help that you can understand, know who to approach and be confident enough to ask for the 1 last update 2020/07/02 support and advice.You also need to know how to get help that you can understand, know who to approach and be confident enough to ask for support and advice.

You can read more about JIA and how it will affect you in our Young people section of the website.

Diagnosis

To make a diagnosis of JIA, a paediatric (young person’s) rheumatologist will examine you and ask you questions. This will probably be done in a hospital.

There isn''s arthritis and the 1 last update 2020/07/02 to rule out other conditions

  • removing fluid from a joint (aspiration) to rule out joint infection
  • bone marrow examination to rule out some rare conditions, especially if they think you have systemic-onset JIA.
  • There isn''s arthritis and to rule out other conditions
  • removing fluid from a joint (aspiration) to rule out joint infection
  • bone marrow examination to rule out some rare conditions, especially if they think you have systemic-onset JIA.
  • arthritis and agehow to arthritis and age for 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.
  • Treatment

    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

    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

    These drugs help to control the pain of the 1 last update 2020/07/02 arthritis.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.

    Read for 1 last update 2020/07/02 about painkillers.Read about painkillers.

    Non-steroidal anti-inflammatory drugs (NSAIDs)

    Non-steroidal anti-inflammatory drugs (NSAIDs) 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.

    Read about NSAIDs.

    Disease-modifying anti-rheumatic drugs (DMARDs)

    Disease-modifying anti-rheumatic drugs (DMARDs) 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.

    arthritis and agehow to arthritis and age for Side-effects of methotrexate are rare, but you’ll need regular blood tests to check for them.

    DMARDs are slow to become effective the 1 last update 2020/07/02 and you may not notice any benefit for several months.DMARDs are slow to become effective and you may not notice any benefit for several months.

    Read about DMARDs.

    arthritis and agehow to arthritis and age for Biological therapies

    Biological therapies is a name given to some the 1 last update 2020/07/02 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.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.

    arthritis and agehow to arthritis and age for 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. Your doctor will try and limit side-effects by putting you on a low dose or short course.
    • Your doctor will give you a steroid card which tells people you’re on steroids. Always carry this with you.
    • 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 the 1 last update 2020/07/02 reduce the inflammation, prevent the swollen iris from sticking to the lens and to reduce pressure inside the eye.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.

    arthritis and agehow to arthritis and age for 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.

    arthritis and agehow to arthritis and age for Key points about your 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.

    If you need to have a vaccination, talk to your rheumatology team or GP. You might need to avoid some live vaccines if you are taking certain DMARDs or biological therapies. For more information about individual drugs, visit our drugs content and search by the name of the drug you are taking. There is a section on vaccinations for each drug.

    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.

    It’s important to discuss what safe limits are with your doctor as this will vary with your age and size.

    arthritis and agehow to arthritis and age for If you’re sexually active, there are some things you should know about certain drugs.

    Women shouldn’t take methotrexate if they are pregnant or trying for a baby, as it can be harmful for an unborn baby.

    Women taking methotrexate should use contraception or encourage their partner to do so, and should carry on using contraception for three months after stopping methotrexate. If you become pregnant while taking methotrexate, you should stop taking it and see your doctor as soon as possible.

    Previously it was recommended that men stop taking methotrexate three months before trying for a baby, but research has now been done that suggests that they may not need to.

    Talk to your rheumatology team if you have any questions or concerns about having sex while on drugs for arthritis.

    There are drugs for arthritis that are safe to take during pregnancy, and it’s important that if a woman is pregnant, her arthritis is under control.

    If you’d like to start a family, it’s a good idea to talk to your rheumatology team before about what drugs you can take. For more information about individual drugs, visit our drugs content and search by the name of the drug you are taking. There is information about this topic for each drug under the section ‘Fertility, pregnancy and breastfeeding’.

    Other treatments

    Physiotherapy and occupational therapy

    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.

    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.

    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.

    Pain relief

    There are various ways to relieve pain, such as hot and cold pads, TENS, acupuncture, massage, hydrotherapy and relaxation. Your physiotherapist will be able to advise you on these.

    If your sleep is affected, it’s good to have a regular routine and some method of pain relief before bed.

    Posture

    arthritis and agehow to arthritis and age for 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. Your therapists will give you advice about the best ways to protect your joints when out and about or performing certain tasks.

    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.

    To ensure you get the right wheelchair for your needs an assessment will be necessary. Remember that 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 drugs pages has been written for adult use and may be different for young people. Speak to your rheumatologist for more specific information the 1 last update 2020/07/02 about medication and young people.Please note that the information on our 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.

    Managing symptoms

    The first thing you can do to help yourself is to find out as much as you can about your condition so that you know what to expect and how it could affect you in the future.

    Another really important thing you can do to help yourself is to improve your general health. You can do this by:

    • eating healthily
    • getting lots of exercise
    • getting enough sleep
    • not smoking
    • avoiding illegal drugs and too much alcohol.

    Exercise

    Exercise is important for general fitness, protects against osteoporosis and helps you to relax. Weight-bearing exercise (such as walking) will help prevent osteoporosis and keep you fit. Try to set aside 15–20 minutes each day to work out. This doesn’t need to be too energetic but you should check that each joint in your neck, spine, arms and legs moves fully. As your arthritis becomes controlled and your general fitness improves you can make the exercises a bit harder.

    Diet

    Your diet is very important when you’re growing up as it keeps you healthy and makes your bones strong. It’s important to take steps when you’re young to help prevent osteoporosis in the future. Eating plenty of dairy products (for example milk, cheese and yoghurt) will help. Generally speaking, you should aim for a well-balanced diet with plenty of fruit and vegetables the 1 last update 2020/07/02 and a high fibre content, avoiding too much fat.Your diet is very important when you’re growing up as it keeps you healthy and makes your bones strong. It’s important to take steps when you’re young to help prevent osteoporosis in the future. Eating plenty of dairy products (for example milk, cheese and yoghurt) will help. Generally speaking, you should aim for a well-balanced diet with plenty of fruit and vegetables and a high fibre content, avoiding too much fat.

    Read more about diet and exercise, or find out more about other ways to manage your symptoms.

    The effects of JIA

    JIA can have different effects on your body, though your symptoms may vary from day to day.

    Flare-ups

    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
    • cause joint pain, swelling and stiffness.

    Sometimes you''stiff-joints''re having a flare-up.

    arthritis and agehow to arthritis and age for 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''puberty''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''growth''teeth''s important to have regular dental check-ups. You for 1 last update 2020/07/02 may need orthodontic advice if arthritis has affected your jaw.If you''growth''teeth''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.

    arthritis and agehow to arthritis and age for Read more about the effect of JIA in our Young people section.

    Related eye condition – uveitis

    If you have JIA, you are at a slightly higher risk of getting an eye condition called uveitis.

    arthritis and agehow to arthritis and age for This involves inflammation in part of the eye, known as the uvea.

    Early treatment can keep it under control and should prevent serious problems. If it isn’t treated, uveitis can cause permanent sight loss.

    It can cause pain and redness in the eyes or blurred vision, but it can also develop without any noticeable symptoms.

    Children and young people with JIA are offered screening by a hospital eye specialist to detect uveitis at an early stage. They'll check your sight and look at your eye with a bright light. This test is painless.

    The treatment for uveitis is steroid eye drops. The drugs methotrexate and adalimumab can also treat it.

    Steroid tablets and steroid drips may be used in some cases.

    arthritis and agehow to arthritis and age for If you have any changes to your vision, or your eyes are painful or red, tell your rheumatology team or GP straight away.

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