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Juvenile Idiopathic Arthritis

Overview

Juvenile idiopathic arthritis refers to a group of chronic arthritic conditions affecting children under the age of 16. 
&nbsp;

It is the most common form of arthritis in children, affecting approximately 1 in 1,000 children globally.<a href="#accordion">[1]</a> Symptoms may start as early as 6 months old.<a href="#accordion">[2]</a> Girls with oligoarticular juvenile idiopathic arthritis outnumber boys by 3:1, while girls with polyarticular juvenile idiopathic arthritis outnumber boys by a 2.8:1 ratio.<a href="#accordion">[3]</a>

Even though most patients struggle with active disease throughout adulthood, almost all children are able to lead productive lives. 
&nbsp;

There are several different subcategories of juvenile idiopathic arthritis, including:<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>
	<h5>Systemic-Onset</h5>
	</li>
</ul>

It is a rare and serious subtype, affecting 1 in 7 or 1 in 10 children with juvenile idiopathic arthritis.

It affects one or more joints. Further, it affects other parts of the body, such as the heart and liver. Symptoms are usually accompanied by a high fever and a skin rash. 
&nbsp;

<ul>
	<li>
	<h5>Oligoarticular</h5>
	</li>
</ul>

It affects fewer than 5 joints during the first 6 months of the disease.

If no more joints are affected after 6 months, it is called persistent. However, if the condition affects more joints, it is referred to as extended. 
&nbsp;

<ul>
	<li>
	<h5>Polyarticular</h5>
	</li>
</ul>

This type affects 5 or more joints during the first 6 months of the disease.

A blood test for rheumatoid factor will help diagnose whether this condition is RF-negative or RF-positive. 
&nbsp;

<ul>
	<li>
	<h5>Enthesitis-Related</h5>
	</li>
</ul>

The child presents with enthesitis along with arthritis. There is a swelling at the point where the bone meets a ligament or tendon, usually in the feet, knees, or hips. 
&nbsp;

<ul>
	<li>
	<h5>Psoriatic Arthritis</h5>
	</li>
</ul>

The child presents with psoriasis along with arthritis. A first-degree relative with psoriasis can be a red flag. Other markers include pits or ridges in fingernails and inflamed toes or fingers.

&nbsp;

<ul>
	<li>
	<h5>Undifferentiated Arthritis</h5>
	</li>
</ul>

This category includes those who have arthritis with two or more subtypes of juvenile idiopathic arthritis. It also includes those who are affected but don&rsquo;t have any symptoms of the aforementioned type of juvenile idiopathic arthritis.

Each subtype presents distinct challenges in diagnosis and management. 
&nbsp;

Sign and Symptoms

The condition is characterized by reduced physical activity. Symptoms often include:

<ul>
	<li>Persistent joint pain</li>
	<li>Limp and stiffness, especially after waking up in the morning</li>
	<li>Swelling</li>
	<li>Rash, swollen lymph nodes, and fever</li>
</ul>

It may affect one or multiple joints. Also, depending on individual circumstances, symptoms may persist for a few months to several years. 
&nbsp;

Causes

The exact cause remains unknown, but a combination of genetic and environmental factors are believed to influence it. For instance, infections and abnormalities in the immune system may trigger the onset in genetically predisposed individuals. 
&nbsp;

Diagnosis

Diagnosis requires a thorough evaluation, including a medical history, a physical examination, and various tests. The following considerations are mandatory for the diagnosis:<a href="#accordion">[3]</a>

<ul>
	<li><a href="https://merisehat.pk/disease/arthritis">Arthritis </a>present for at least 6 weeks</li>
	<li>Limited participation in physical education classes or history of school absences</li>
	<li>Temporary rash on the trunk or extremities</li>
	<li>Spiking fever once or twice daily at about the same time of day</li>
	<li>Certain dermatologic conditions</li>
</ul>

Healthcare professionals may order blood tests, such as ESR, CRP, CBC, serum creatinine, antinuclear antibody, and HLA-B27 tests. Additionally, imaging modalities such as a CT scan, MRI, and ultrasonography may help with the diagnosis. 
&nbsp;

Treatment

Early diagnosis, prompt intervention, and ongoing medical management are essential to minimize the impact of the condition on a child&#39;s life.

Juvenile idiopathic arthritis management is multidimensional, involving:<a href="#accordion">[3]</a>

<ul>
	<li>Pharmacologic therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and, in some cases, biologic agents or corticosteroids</li>
	<li>Improved nutrition and regular exercise</li>
	<li>Occupational therapy</li>
	<li>Psychosocial interventions</li>
</ul>

In severe cases, surgery may be necessary. 
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If left untreated, it can lead to joint deformities, growth problems, and complications related to inflammation in other parts of the body, such as changes in vision, <a href="https://merisehat.pk/disease/anemia">anemia</a>, and pericarditis.<a href="#accordion">[5]</a> 
&nbsp;

The following factors make individuals vulnerable to developing juvenile idiopathic arthritis:

<ul>
	<li>Genetic predisposition</li>
	<li>Family history of autoimmune conditions</li>
	<li>Exposure to certain environmental factors</li>
	<li>Sex, with females being more commonly affected than males 
	&nbsp;</li>
</ul>

Currently, there are no preventive measures for this condition. 
&nbsp;

Key Points

<ul>
	<li>Juvenile idiopathic arthritis is a type of chronic arthritis that affects children under the age of 16.</li>
	<li>It is characterized by persistent joint inflammation, causing pain, swelling, and potential joint damage.</li>
	<li>A comprehensive evaluation, including physical examination, blood tests, imaging, and joint fluid analysis, can help diagnose it.</li>
	<li>Early detection is crucial to prevent long-term joint damage.</li>
	<li>Treatment of juvenile idiopathic arthritis involves medication, physical therapy, and lifestyle adjustments.</li>
	<li>If left untreated, it can lead to joint deformities, growth problems, and complications in other organs.</li>
</ul>

[1] Juvenile arthritis. Accessed January 9, 2024.

[2] Juvenile idiopathic arthritis: Medlineplus Medical Encyclopedia. MedlinePlus. Accessed January 9, 2024.

[3] David D Sherry M. Juvenile idiopathic arthritis. Practice Essentials, Background, Etiology and Pathophysiology. May 3, 2022. Accessed January 9, 2024.

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