Juvenile Arthritis: Know the Signs and Treatment Options

Juvenile Arthritis: Know the Signs and Treatment Options

Utilization Management Insights
By Kathryn Kolonic, , DO, MPH, CPHQ
AllMed Vice President & Medical Director

 

Did you know that the term juvenile arthritis (JA) describes not one disease but many? Most people don’t. But in fact, this umbrella term covers a variety of inflammatory and rheumatic diseases that affect nearly 300,000 children under age 16 in the United States.¹ These often-painful conditions can cause serious complications, including bone and joint damage that can result in growth problems and eye inflammation that can lead to glaucoma, cataracts, and even blindness. In addition, children with JA are more likely to feel depressed due to the unpredictable pain and limitations that can accompany the disease.² Fortunately, though JA can be chronic and long-lasting, effective treatments exist. A timely, accurate diagnosis is the key first step to minimizing JA’s impact on children’s lives.

Causes and Symptoms

While some types of JA develop from infections, most are autoimmune disorders occurring when the immune system mistakenly attacks some of its own healthy cells and tissues. The causes of these dysfunctions are not known, but researchers believe that certain genes may cause JA when activated by a virus, bacteria, or other external factors.³ The subset of juvenile arthritis comprised of autoimmune disorders is called juvenile idiopathic arthritis (JIA)—idiopathic means from an unknown cause.

Symptoms can vary greatly, but JA often affects joints, resulting in pain, stiffness, and/or swelling and potentially causing damage that makes it hard to walk or dress. Sometimes, if bone becomes damaged in a growth area, then bones may grow at different rates or develop abnormally in shape or size. This can lead to one leg being permanently shorter than the other.

Some types of JA have few or no joint symptoms but affect the skin and internal organs instead. Children with these types may have silent eye inflammation, fevers, or rash.

Common Types of Juvenile Idiopathic Arthritis

The most common forms of JA are the autoimmune disorders that include⁴:

• systemic arthritis, which affects many joints and organs and commonly has symptoms such as repeating high fevers and a pink rash that comes and goes.
• oligoarthritis, which affects fewer than five joints and is the most common form of JA. Children with this type of arthritis are particularly susceptible to eye inflammation and must be evaluated often by an ophthalmologist. They may not have symptoms, but permanent eye damage can occur even if other symptoms of arthritis are under control. Fortunately, treatment for eye inflammation is highly effective.
• polyarthritis, in which five or more joints are affected, usually involves small joints such as in fingers and toes. Polyarthritis is more common in girls than in boys and is usually more severe than systemic or oligoarthritis.
• psoriatic arthritis, which commonly strikes some children with psoriasis and appears to have a genetic component. In addition to joint pain and inflammation, the primary symptoms are pitted fingernails, psoriasis, and a raised, scaly rash behind the ears, near the navel, or in other areas.
• enthesitis-related arthritis, which causes inflammation where the tendon joints attach to the bone, in the joint, bone, or both. Morning stiffness is a symptom of this type, and it improves with exercise. Eye inflammation is also common.
• lupus, which most often affects adolescent girls and young women and is unpredictable, causing inflammation and tissue damage in various areas of the body at different times.

These conditions can be very difficult to diagnose because many diseases have similar symptoms. For this reason, children with symptoms of arthritis are often referred to a pediatric rheumatologist.

Diagnosis and Treatment

There is no single laboratory test or symptom that provides positive proof of juvenile arthritis, so diagnosis is typically based on medical history review and a physical exam. Before reaching a diagnosis, a rheumatologist must rule out other possible causes of symptoms such as Lyme disease, infection, and childhood cancer.

Treatment focuses on reducing inflammation to prevent further damage to joints and on alleviating symptoms, so the child can function as normally as possible. If only a few joints are affected, a steroid injection might be used to ease pain and swelling. In some cases, low-dose, short-term corticosteroids, such as prednisone, might be used. However, because corticosteroids can inhibit growth, they are used sparingly. When steroid injections don’t work or when many joints are affected, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or biologic drugs may help. The relatively new tofacitinib (Xeljanz), approved by the Food & Drug Administration (FDA) in 2021, is the first oral medication option available to patients with juvenile arthritis. In addition to medication, physical or occupational therapy may be prescribed to improve function, endurance, joint flexibility, and strength.

Early Treatment Improves Outcomes

With early diagnosis and aggressive treatment, children with juvenile arthritis can lead normal lives and, in many cases, even achieve remission. Though there is still no cure, new medications have dramatically improved young JA patients’ prospects, making it possible for most to get well and experience no permanent disability.

Board-certified pediatric rheumatologists from AllMed can provide the necessary expertise to ensure that your members with juvenile arthritis are diagnosed correctly and treated effectively. Rely on AllMed for expert support when you need it.

 

1. Arthritis Foundation. Juvenile Arthritis (JA). https://www.arthritis.org/diseases/juvenile-arthritis. Accessed June 27, 2023.
2. Delzell, Emily. Juvenile Arthritis and Depression. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/emotional-well-being/anxiety-depression/juvenile-arthritis-and-depression. Accessed June 29, 2023.
3. Arthritis Foundation. Juvenile Arthritis (JA).
4. Harvard Health Publishing. Juvenile Arthritis. Harvard Medical School. Updated March 23, 2023. https://www.health.harvard.edu/pain/juvenile-arthritis-a-to-z. Accessed June 27, 2023.
5. Watson, Stephanie. JIA and Remission: What You Should Know. Arthritis Foundation. https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/jia-and-remission. Accessed June 28, 2023.
6. Ibid