Though mostly associated with old age, arthritis can also occur in children — which is why it is important to take note if a child frequently complains about pain in the joints.
Regular joint pain, stiffness and swelling are classic symptoms of juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis or child arthritis. JIA is usually seen in children aged less than 16 and tends to persist for more than six weeks.
It is an autoimmune disorder with no definite cause. Interaction between certain genes could be a reason, besides environmental triggers that impact the immune system.
“The association between HLA (human leukocyte antigen) genes and arthritis is well-known,” says Dr Reena Jaybhaye, a consultant rheumatologist and immunologist at Advanced Arthritis and Rheumatology Centre, Mumbai. “For example, HLA-B27 is known to cause enthesitis-related arthritis, which is a type of JIA. Various environmental factors have been suggested to play a role in its pathogenesis. Especially, infections and vaccinations have been suggested as possible environmental factors that could cause JIA.”
However, she adds, studies so far have failed to link vaccination with the onset of JIA. “Importantly, various studies have now shown that vaccination in children with established JIA is overall safe and effective,” says Dr Jaybhaye.
Juvenile idiopathic arthritis impacts daily life
JIA is characterised by joint pain, swelling and early-morning stiffness.
“On some days, I could not wake up in the morning to attend school because there would be so much pain,” recalls 15-year-old Janvi Sandeep Jamnik, a Class X student from Belapur, Maharashtra. “My legs would go numb sometimes and I could not even walk. I had to take support of walls or whatever things my hands could reach — otherwise I would fall. It was such a nightmare for me.”
Jamnik was diagnosed with JIA when she was nine. It led to a lot of confusion, and she and her family struggled to get a proper diagnosis.
“Many affected children show symptoms during their preschool or early-school years, and often have difficulty describing their symptoms,” says Dr Jaybhaye. “Parents are likely to note limping, particularly if the lower limb joints are affected.”
Diagnosing juvenile idiopathic arthritis
The diagnosis involves clinical tests that are supported by radiological and laboratory evidence.
“JIA is a diagnosis of exclusion and a wide range of differential diagnoses, many of which have recognisable features on imaging, needs to be ruled out,” says Dr Jaybhaye. “CR [computed radiography] is the first imaging modality which should be performed to exclude other causes of joint pain and swelling such as trauma, osteoid tumours [and] skeletal dysplasia. [For] those with established JIA, X-ray remains the gold standard for the demonstration of cumulative structural damage to the joints resulting from uncontrolled inflammation over time.”
Since an X-ray might not pick up the early changes of arthritis, ultrasonography or MRI may be used, she adds.
Treating and managing JIA
JIA has several subtypes — so, treating and managing it depends on the subtypes. Since JIA can lead to joint deformities if left untreated for a long time, early diagnosis is the key in management.
“Treatment includes use of DMARDS [disease modifying anti-rheumatic drugs] and short courses of steroids,” says Dr Jaybhaye. “Treatment should be supervised by an expert in the field. Routine evaluation and lab tests are needed. Along with DMARDS, supplementation with vitamin D and calcium is needed. Diet should include calcium-rich food, and junk food needs to be avoided.”
The outcome has been positive in the case of Jamnik, the teenager from Belapur.
After years of skipping appointments and taking medications only irregularly for various reasons, she has regularised her schedule and clinic visits in the past six months.
“Now, everything is fine,” she says. “I can finally walk properly. I had not run for one year because of the pain, but now I’m running. I have started to do yoga and exercise in the morning and evening as well.”
Jamnik has developed a positive approach towards her condition, which helps her to manage it better. “The negative energy I created and felt around me during the initial years after the onset of the disease led to it taking over [my life],” she says. “So, I started to accept the disease and I have learned so much about it. Now everyone around me is supportive and treats me like a normal person — for which I’m happy.”
Takeaways
- Juvenile idiopathic arthritis (JIA) — also known as juvenile arthritis or child arthritis — is an autoimmune disorder seen in children below 16 years of age.
- JIA is characterised by joint pain, swelling and early-morning stiffness.
- Its diagnosis involves clinical tests supported by radiological and laboratory evidence. It can be treated using DMARDS and short courses of steroids.
