Juvenile Idiopathic Arthritis (JIA)

Gillette Children’s Specialty Healthcare’s Pediatric Rheumatology Program offers comprehensive evaluations, diagnoses and treatments for children who have juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis (JRA). As a regional referral center, Gillette treats hundreds of new patients from Minnesota and the Upper Midwest every year. Our experienced team of rheumatology specialists works with children and their families to minimize symptoms, maintain mobility, and improve joint function.

Why Gillette?

  • We collaborate with the University of Minnesota and the Mayo Clinic to investigate the role genetics plays in juvenile idiopathic arthritis.
  • Our interdisciplinary team offers comprehensive support for related complications, including issues with physical growth and joint pain.
  • We treat children with a broad range of rheumatic conditions, giving us an unmatched depth of expertise.
  • Our approach helps patients develop physically and emotionally while learning to manage their conditions.

Definition and Incidence

Juvenile idiopathic arthritis is chronic joint inflammation lasting at least six weeks in someone 16 or younger. Left untreated, this inflammation can permanently damage joints. The most prevalent form of childhood arthritis, it affects approximately 50,000 children in the United States.

Inflammation can affect one joint or many joints, causing swelling, warmth, pain and stiffness. Other symptoms may include fevers, rashes, or eye inflammation.  These symptoms can worsen (flare-ups) at times, then improve or disappear (remissions) during others.


Types of Juvenile Idiopathic Arthritis

While there are many categories of juvenile idiopathic arthritis, the three most common types are oligoarticular, polyarticular and systemic. 

Oligoarticular  

This form affects four or fewer joints — usually large joints such as knees, ankles or elbows. It often affects a particular joint only one side of the body. The most common form, it appears more often in girls than boys. Young children who develop oligoarticular arthritis may be at increased risk for eye inflammation, called iritis. Eye inflammation usually does not cause noticeable symptoms, but can cause permanent damage if untreated. Children with this form, therefore, should receive regular eye exams.

Polyarticular

This form affects five or more joints — typically small joints such as those in the hands and feet, weight-bearing joints such as the knees, ankles and feet, as well as the neck and jaw joints. It often affects the same joint on both sides of a child’s body.

Systemic

Sometimes known as Still’s disease, this form affects many areas of the body, including joints and internal organs. It is the least common form, affecting approximately 10 percent of children who have juvenile arthritis. It generally causes spiking fevers and a rash of pale red spots, often on the trunk or limbs.  This form affects boys and girls equally, and rarely causes eye inflammation.


Juvenile Idiopathic Arthritis Causes and Risk Factors

Juvenile idiopathic arthritis is an autoimmune disease — one in which the immune system turns against the body’s own cells and tissues, instead of confining its attacks to infections and tumors. No one knows why some people develop autoimmune diseases.

Still, experts have identified many of the genes that regulate the immune system and predispose people to arthritis. It’s also clear that trauma, infections, excessive wear or stress on joints, and other disturbances can contribute to or aggravate rheumatic diseases. Nevertheless, it’s impossible to predict who will develop juvenile idiopathic arthritis.

Gillette’s pediatric rheumatologists work closely with the University of Minnesota and the Mayo Clinic on research to determine the cause of juvenile arthritis and other rheumatic conditions.


Symptoms and Effects of Juvenile Idiopathic Arthritis

Joint inflammation is a key component of active arthritis. When the lining of a joint produces too much fluid, the joint becomes swollen, causing warmth, pain and stiffness. While symptoms of juvenile idiopathic arthritis may vary depending on its type and severity, warning signs can include:

  • Stiffness in the morning or when awakening after a nap
  • Limping
  • Complaining of pain
  • Lingering fever, rash, or swollen glands
  • Holding a joint still, or refusing to use an arm or leg
  • Fatigue and noticeably reduced energy level

Like other forms of arthritis, symptoms can be worse (flare-ups) at times and improve or disappear (remissions) during some periods. Juvenile idiopathic arthritis is different in each child. Some children might experience just one or two flare-ups, then never have symptoms again. Others might experience many flare-ups or even have permanent symptoms.

Associated Complications

Children with juvenile idiopathic arthritis can also be at risk for several associated issues. Eye inflammation, called iritis, occurs more frequently in children with arthritis. Because this can be difficult to observe—and often doesn’t cause discomfort—children should see an ophthalmologist regularly.

Because joint inflammation also alters the speed at which bones grow, individual bones might become longer, shorter, bigger or smaller than normal. Abnormalities of bone and muscle development also can affect a child’s gait, causing frustration or decreasing a child’s ability to participate in social activities. Growth usually improves or normalizes once the arthritis is under control.


Diagnosing Juvenile Idiopathic Arthritis

Symptoms of juvenile idiopathic arthritis are different for each child, which can make diagnosis challenging. If a pediatrician suspects the condition, they will refer the child to Gillette’s pediatric rheumatologists for evaluation, diagnosis and treatment.  

Gillette’s rheumatology team uses a series of diagnostic tests to eliminate other diseases whose symptoms resemble juvenile idiopathic arthritis. Viral infections, bacterial infections (such as Lyme disease), inflammatory bowel disease, lupus, dermatomyositis, and some forms of cancer can produce similar symptoms.

  • X-rays or MRI exams can confirm or exclude fractures, tumors, infections and congenital defects.
  • Blood tests can rule out other illnesses, classify a particular type of arthritis, and predict a child’s likelihood for developing eye inflammation that sometimes accompanies the condition.

If test results confirm a diagnosis of juvenile idiopathic arthritis, our pediatric rheumatologists work with families to implement an effective treatment plan. 


Treatments for Juvenile Idiopathic Arthritis

Once a diagnosis of juvenile idiopathic arthritis is confirmed, we begin treatment with anti-inflammatory or immune-suppressive medications to relieve pain and block inflammation.  Medications are given by injection directly into the affected joint, or by IV infusion into the bloodstream.

Depending on the child and the severity of arthritis, other treatments and interventions might include:

  • Physical and occupational therapy to stretch joints and strengthen muscles, leading to improved mobility and range of motion
  • Orthoses (braces), shoe inserts or splints to support affected joints and relieve pain
  • Exercise and physical activity to reduce joint pain and stiffness
  • Proper nutrition to help with weight control, minimizing strain on joints
  • Massage to relax the muscles surrounding inflamed joints
  • Surgery, in extreme cases, to release tissue causing joint contractures and remove inflamed tissue

Our Juvenile Idiopathic Arthritis Services

Juvenile idiopathic arthritis can be successfully managed when the condition is correctly diagnosed and treated. Gillette’s experienced team of pediatric rheumatology experts can minimize the impact of juvenile idiopathic arthritis on everyday life, helping reduce, or even eliminate, a child’s symptoms. Our specialists can provide medications and other interventions to help your child lead a normal and active life.  

For more information about our comprehensive services, search Conditions and Care.