Juvenile arthritis is a common cause of joint pain and other symptoms in children and adolescents.
The most common cause of arthritis in children and adolescents is juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis and juvenile chronic arthritis. While rates of juvenile arthritis vary around the world, in the United States, around 300,000 children and adolescents are affected.
Physicians are not completely sure what causes JIA, but we believe genetic and environmental factors play a role. One theory is certain infections can "trigger" the onset of JIA in children who are genetically prone to the disease. JIA itself is not contagious.
Your child's physician may begin to think about JIA if your child has had joint pain for six weeks or more before 16 years of age. There are other symptoms of JIA in addition to joint pain, including morning joint stiffness, swelling of joints, redness or pain of the eye(s), fevers, enlarged lymph nodes and a pink rash that may come and go.
While very rare, some children with JIA don't have pain at all.
In young children who can't yet communicate well about their pain, figuring out what is wrong can be difficult for both parents and doctors. But there are a few clues. Young children affected by JIA are often fussy and limp, particularly in the morning or after naps. They may also seem less active or less willing to walk or crawl than usual.
When your child's pediatrician is worried about JIA, the assessment will begin by talking to you and your child about the history of your child's symptoms. You may be asked questions about the length of time your child has had pain, what times of day they have pain, whether or not the pain gets better as the day progresses, and things that make your child's pain better or worse.
Your child's pediatrician will also consider other causes of joint pain in children, such as injuries, tick-bite-related infections, bacterial infections in joints and inflammation in joints that sometimes follow the "common cold." Through these questions - and later the physical exam, labs and X-rays - they will try to rule in or rule out these other possibilities.
After discussing your child's symptoms, your child's doctor will need to perform a thorough physical exam with your child. The pediatrician will closely look at all of your child's joints and skin and may ask your child to walk, jump or perform other tasks to observe how their joints are working.
Following the physical exam, your child's doctor will decide if any other laboratory tests, X-rays or other imaging studies are needed. Sometimes they are not, but your child may need a blood draw or an X-ray.
There is currently no laboratory test or imaging study that can definitely say whether or not a child has juvenile idiopathic arthritis, but there are many tests that are helpful in making the diagnosis. Common tests your child's doctor may order include white blood cell counts and inflammatory markers such as rheumatoid factor, erythrocyte sedimentation rate and c-reactive protein. In the summer and fall, they may also order tests to rule out tick-bite-related infections. X-rays of affected joints can be useful in ruling out injuries or other structural causes of joint pain.
Diagnosis of JIA is based on multiple factors, including the history of symptoms, physical exam findings, laboratory findings and images of bones and joints. If your child's doctor strongly suspects JIA, your child will likely be referred to a pediatric rheumatologist for additional evaluation and treatment. Pediatric rheumatologists are experts in arthritis and auto-immune diseases in children. Pediatric rheumatology is available in Columbia, as well as Kansas City and St. Louis. There is not currently a pediatric rheumatologist working in Jefferson City.
There is no cure for JIA, but there are many treatments that can help children manage their symptoms. These treatments range from simple NSAIDs, such as ibuprofen or naproxen, to more advanced and specialized medications. Regular eye and dental care is important for children with JIA as well.
If you are concerned your child may have juvenile arthritis, you should contact your family's pediatrician for an appointment to discuss your concerns. For more information about JIA and other forms of arthritis, visit the Arthritis Foundation at arthritis.org.
Bethany Crawford, MD, is a pediatrician with SSM Health Medical Group in Jefferson City.