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Juvenile Idiopathic Arthritis (JIA)

by Dr. Justin Tan Hung Tiong




 “Juvenile Idiopathic Arthritis” (JIA) is a term used to describe arthritis in children.  ‘Juvenile’ means under 16 years of age, ‘Idiopathic’ means the cause of arthritis is still unknown, ‘Arthritis’ means joint inflammation. 


“幼年特发性关节炎(Juvenile Idiopathic Arthritis, JIA)”是指发生于儿童和青少年时期的关节炎症。其中,“幼年(Juvenile)”表示发病年龄低于16周岁,“特发性(Idiopathic)”意味着其具体病因不明,而“关节炎(Arthritis)”则指发生于关节处的炎症。



What is Juvenile Idiopathic Arthritis ? 




Juvenile Idiopathic Arthritis is an autoimmune disease affecting one or more joints for more than 6 weeks in children before his/her 16th birthday. There are 7 subtypes of juvenile idiopathic arthritis, which your child may fit into one of them.  Different subtypes of JIA have different disease course and vary in prognosis. 





What causes Juvenile Idiopathic Arthritis ?




The cause of JIA is still unknown. It is believed that the interactions between genetic predisposition and environmental factor play a role in the pathogenesis. 





What are the signs and symptoms ?




Signs of joint inflammation include joint swelling, pain, increased in warmth and limitation of joint movement. Some children may experience joint stiffness. These symptoms are typically worse in the morning. If your child limps or refuses to move the affected joints especially in the morning (lasting more than 30 minutes for 3 consecutive days), this is one of the alarming signs that you should consult the doctor early. 





How is the diagnosis of JIA made ? 




Diagnosis is made based on history and clinical assessment by doctors. There is no laboratory test which confirms the diagnosis of JIA. Your doctor may perform some blood tests to help in differentiating JIA from other diseases and predicting the disease course and potential complication risks. These tests are usually done in your first clinic visit. 





What are the available treatments? 




JIA is treatable. Over the years, treatment for JIA has developed rapidly. An increasing number of newer and effective treatments are approved for use in JIA. Treatments of JIA include non-steroidal anti-inflammatory drugs (NSAIDS), disease modifying anti-rheumatic drugs (DMARDS) such as methotrexate, steroids (prednisolone) and biologics (Enbrel, Humira, Remicade).




Joint fluid aspiration with intra-articular steroids joint injection is a treatment option for some patients. 




Your doctors will advise you on the treatment required for your child as the treatment is individualized. It is extremely important for you to be COMPLIANT with the treatment and follow-up. 





Is there any lifestyle modification or limitation ?




Your child should be encouraged to involve in physical exercises. Your doctor may advise temporary joint rest if the joint is inflammed. Otherwise, your child has no limitation in physical activities.  Physical injuries should be prevented at all times. 





Is there any dietary restriction ?




NO. You are advised to speak to your doctor first if you decide to start your child on any health supplements or traditional medications as some of these medications may interact with the medications prescribed by your doctor. 





Do my child need regular blood tests ? 




Regular blood tests are used to monitor side effects of medications. Your doctor will advise you on the frequency of blood tests, which is usually more frequent during the first 2 months when your doctor starts your child on a new medication. 





What are the potential complications ? 




Untreated or poorly controlled joint disease will result in joint damage, muscle wasting (disuse atrophy), leg length discrepancy, growth failure and permanent disability. 





Do my child need physiotherapy ? 




Your doctor will advise you on when physiotherapist will be involved in the management of your child’s condition. Physiotherapy via stretching and strengthening exercises help in the recovery and restoration of the joint function. 





Can I vaccinate my child ? 




You need to inform the doctor if you are going to send your child for vaccination as live vaccines, for example MMR, oral polio and varicella zoster vaccine, are contraindicated when the child is on certain treatment (methotrexate/biologics) 





What is the likely outcome of the disease ? 




In general, there is no cure for JIA but it has good prognosis with adequate and early treatment. Every child responds differently to treatment. Therefore, it is difficult to predict the outcome of the disease, and risks of recurrence depend on the disease subtypes.  Course of disease may fluctuate with time. Some children may go into what doctors call as “remission’, which means that the symptoms disappear and sometimes, never comes back again although unfortunately, many recur. Therefore, early identification of disease flare is important. 





How do I detect flare in my child’s condition?




Contact your doctor if your child has limping in the morning for 3 consecutive days or if there are presence of joint swelling and/or pain. 





If you have any queries about your child’s condition, you can contact us. 



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