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Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that affects children. It used to be known as juvenile rheumatoid arthritis, but the name was recently changed to reflect the differences between childhood arthritis and adult forms of rheumatoid arthritis.
JIA is a chronic (long-lasting) disease that can affect joints in any part of the body. In this disease, the immune system mistakenly targets the synovium, the tissue that lines the inside of the joint. The synovium responds by making excess fluid (synovial fluid), which leads to swelling, pain and stiffness. The synovium and inflammation process can spread to the surrounding tissues, eventually damaging cartilage and bone. Other areas of the body, especially the eyes, also may be affected by inflammation. Without treatment, JIA can interfere with a child’s normal growth and development. There are several main subtypes of JIA, which are based on symptoms and the number of joints involved.
Systemic arthritis — Also called Still’s disease, this type occurs in about 10 to 20 per cent of children with JIA. A systemic illness is one that can affect the entire person or many-body systems. Systemic JIA usually causes a high fever and a rash, which most often appears on the trunk, arms and legs. It also can affect internal organs, such as the heart, liver, spleen and lymph nodes. This type of JIA affects boys and girls equally and rarely affects the eyes.
Oligoarthritis — This type of JIA affects fewer than five joints in the first six months of disease, most often the knee, ankle and wrist joints. It also can cause inflammation of the eye (often the iris, the coloured area of the eye), called uveitis, iridocyclitis or iritis. About half of all children with JIA have this type, and it is more common in girls than in boys. Many children will outgrow this type of arthritis by adulthood. In some children, it may spread to eventually involve more joints.
Polyarthritis — This type of JIA affects five or more joints in the first six months, often the same joints on each side of the body. Polyarthritis can also affect the neck and jaw joints as well as small joints, such as those in the hands and feet. It is more common in girls than in boys.
Psoriatic arthritis — This type of arthritis affects children who have arthritis with the rash of psoriasis. Children frequently have nail changes that look like pitting. Arthritis can precede the rash by many years or vice versa.
Enthesitis-related arthritis — This type of arthritis often affects the spine, hips and enthesis (attachment point of tendons to bones) and occurs mainly in boys older than eight years. The eyes are often affected by this type of arthritis. There is often a family history of arthritis of the back (spondylitis) in male relatives.
Symptoms vary depending on the type of JIA and may include: Morning stiffness, Pain, swelling and tenderness in the joints Limping (younger children may not be able to perform motor activities that they recently learned.)
Fever, Rash, Weight loss
Fatigue or irritability
Eye redness, eye pain, and blurred vision
The exact cause of JIA is not known. However, researchers are studying several factors that may be involved, alone or in combination, in triggering the inflammatory reaction seen in JIA. These factors include genetics, infection, and environmental factors that influence the immune system. JIA, however, is not a hereditary disease like cystic fibrosis, for example.
JIA is the most common type of arthritis in children. It affects about 1 in 1,000 children, or about 300,000 children in the United States.
There are no tests that specifically diagnose JIA. Rather, JIA is a diagnosis of exclusion, which means the doctor works to rule out other causes of arthritis and other diseases as the cause of the symptoms. In making a diagnosis of JIA, the doctor usually begins with a complete medical history that includes a description of symptoms and a complete physical examination. Imaging techniques such as X-rays or magnetic resonance imaging (MRI) can sometimes show the condition of the joints. Laboratory tests on blood, urine, and/or joint fluid may be helpful in determining the type of arthritis. These include tests to determine the degree of inflammation, antinuclear antibody (ANA), and rheumatoid factor. These tests also can help rule out other diseases — such as an infection, bone disorder, or cancer — or an injury as the cause of your child’s symptoms.
The goals of treatment are to relieve pain, reduce swelling, increase joint mobility and strength, and prevent joint damage and complications. Treatment generally includes medications and exercise. Medications used to treat JIA include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) — These medicines provide pain relief and reduce swelling but do not affect the course or prognosis of JIA. Some are available over the counter, and others require a prescription. Examples include ibuprofen and naproxen. These medicines can cause nausea and stomach upset in some people and need to be taken with food.
Corticosteroids (steroids) — In patients with oligoarthritis or in patients with very painful/ swollen joints with other types of JIA, these medications are very effective when given as an injection (shot) into the affected joint. If a child is younger or if several joints are injected, sedation is often used. In patients with more severe widespread disease, these medications occasionally need to be given by mouth as a pill. These medicines, when given by mouth, are effective but can have serious side effects—including weakened bones —especially when used for long periods. Doctors generally try to avoid using steroids in children because they can interfere with a child’s normal growth.
Disease-modifying anti-rheumatic drugs (DMARDs) — These medications work by changing, or modifying, the actual disease process in arthritis. The aim of DMARD therapy is to prevent bone and joint destruction by suppressing the immune system’s attack on the joints. Methotrexate (Rheumatrex®, Trexall®) is the DMARD most often used to treat JIA. Other medications used include sulfasalazine (Azulfidine®) and leflunomide (Arava®).
Biological modifying agents — Biological agents are medications that directly target molecules or proteins in the immune system that are responsible for causing inflammation. They are given by injection or by infusion and are used to treat children with more severe arthritis that is not responsive to other medications. Etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), abatacept (Orencia®) and anakinra (Kineret®) are examples of this type of medication.
Exercise and physical and occupational therapy can help reduce pain, maintain muscle tone, improve mobility (ability to move) and prevent permanent handicaps. In some cases, splints or braces also may be used to help protect the joints as the child grows. Special accommodations with schools may be needed to adjust for children with limitations from their arthritis. The Americans with Disabilities Act (“504” plan) can help facilitate these issues.
JIA affects each child differently. For some, the disease is mild and easy to control, with only one or two joints affected. For others, JIA may involve many joints, and the symptoms may be more severe and may last longer. With the help of modern medical, physical, and occupational therapy, it is possible to achieve good control of arthritis, prevent joint damage, and enable the normal or near-normal function for most patients. Early detection and treatment may help to control inflammation, prevent joint damage, and maintain your child’s ability to function.
If it is untreated, JIA can lead to: Loss of vision or decreased vision due to iridocyclitis/uveitis
Permanent damage to joints
Chronic arthritis and disability (loss of function)
Interference with a child’s bones and growth
Inflammation of the membranes surrounding the heart (pericarditis) or lungs (pleuritis)
Although it might not seem possible, a disease that affects the joints can sometimes also affect the eyes. Children with juvenile idiopathic (formerly called rheumatoid) arthritis (JIA) can develop eye problems either as a result of the disease itself or, rarely, as a side effect of some medicines. This information will help you learn more about how JIA might affect your child’s eyes. The eye functions in the same way as the inner workings of a camera.
The front of the eye admits light rays through the cornea, the pupil (the middle of the iris that determines how much light enters the eye), and a transparent fluid known as the aqueous humour in the anterior chamber.
Next, the lens focuses that light through a clear gel-like substance called the vitreous humour onto the retina. The retina is a thin layer of tissue that makes up the inner lining of the back of the eye. The retina works like the film in a camera, transforming light into images. It converts the light rays to impulses that travel along the optic nerve to the brain. The brain integrates the images sent from both eyes and interprets them as a single, three-dimensional image, allowing us to perceive depth and distance.
If any of the parts of the eye become damaged, changes in eyesight can occur.
What are some common eye problems that might affect children with JIA?
Uveitis is the most common eye problem that can develop in children with JIA. Uveitis is an inflammation of the inner parts of the eye. The uvea consists of the iris (the coloured portion of the eye), the ciliary body (which produces fluid inside the eye and controls the movement of the lens) and the choroid (which lines the eyeball from the iris all the way around the eye).
Uveitis might also be known as iritis or iridocyclitis, depending on which part of the eye is affected by inflammation. If the inflammation is not detected and treated early, scarring and vision problems can occur. Glaucoma, cataracts, and permanent visual damage (including blindness) are all complications that could result from severe uveitis.
Uveitis can occur up to one year before, at the same time as, or up to 15 years after JIA is diagnosed. It can also occur several years after JIA is in remission (the disease is not active). The severity of the child’s joint disease does not determine how serious the uveitis might be. However, eye problems are more common in children with oligoarthritis (less than five joints with arthritis in the first six months of disease). Eye problems are also more likely if your child has a positive blood test for antinuclear antibodies (ANA). They are most likely to occur in female toddlers.
How will I know if my child is developing eye problems?
Because eye inflammation usually is not painful and the eyes are usually not red (“pink”), most children with JIA who develop eye problems do not have any symptoms. Rarely, children might complain of light bothering their eyes or blurred vision. Sometimes your child’s eyes might look red or cloudy. However, these symptoms usually develop so slowly that permanent eye damage can occur before any visual difficulties are noticed.
In order to detect eye problems and prevent them from causing damage, your rheumatologist will schedule frequent appointments with a pediatric ophthalmologist.
How can eye problems be prevented?
Carefully follow your health care provider’s medicine guidelines and keep all your scheduled appointments with your rheumatologist and ophthalmologist, even if you don’t think your child has eye problems or if the JIA is less active.
How often should my child have eye examinations?
The frequency of your child’s eye exams will depend on the type of JIA he or she has, how long your child has had arthritis, and what medicines have been prescribed to treat it. Because uveitis is more common in children with certain types of JIA, such as oligoarthritis, or in polyarthritis with a positive ANA, more frequent eye examinations (every three to four months) might be recommended. Children with polyarthritis (when ANA is negative) require an examination every six months, and patients with systemic JIA usually need an ophthalmologist examination every 12 months. Eye exams should continue after your child’s arthritis goes into remission. Ask your rheumatologist and ophthalmologist how often your child’s eye exams should be scheduled and follow their recommendations. If eye problems are detected, more frequent examinations will be necessary.
How can eye problems be treated?
If eye problems occur, your rheumatologist and ophthalmologist will discuss ways to treat them to prevent permanent eye damage. If uveitis is diagnosed, different types of eye drops might be prescribed. Eye drops to dilate the eyes may be prescribed in order to keep the pupils open and help prevent scarring. Steroid (cortisone) might be prescribed to reduce swelling and decrease inflammation. However, long-term use of steroid eye drops can have significant side effects such as glaucoma and cataracts.
If eye drops are not effective in decreasing inflammation, oral steroids (taken by mouth) might be prescribed. Oral or injectable methotrexate is now often used to treat significant eye inflammation, so the long-term side effects of steroids can be avoided. In cases of severe uveitis, new “biologic modifying medicines,” such as infliximab (Remicade®) or adalimumab (Humira®), may be used.
RAJESH KUMAR AGGARWAL5 October 2023Dr. Himanshu Aggarwal is very humble and experience doctor in his field.Vinay Gupta4 October 2023Really an eminent doctor..His diagnosis helped me a lot, ..May God bless him...Ritik Singh.22 September 2023Dr. Himanshu Aggarwal (Rhemutologist)is good in nature. he gives enough time to patient to satisfaction, and clear all the quarries of the patient.Vishesh Singla22 September 2023I visited Dr himanshu aggarwal for my relative's arthritis nd within few weeks she start getting relief.. Thanks to himYogendra Singh13 September 2023डॉक्टर हिमांशु अग्रवाल जी मैक्स अस्पताल में जो हड्डी ज्वाइंट का इलाज करते हैं मेरा भी इलाज किया और मैं अपने को शत प्रतिशत ठीक महसूस करता हूं डाक्टर साहब जी को कोटि कोटि प्रणाम करता हूंJai Rawat29 August 2023Excellent Doctor, Great humanitarian Dr Himanshu Aggarwal listens very patiently & gives sufficient time to say his problem.He studies the patient and disease meticulously.He is very cheerful and gentle in his behavior.I think he is best rheumatologist in Dehi,Ghaziabad NCR.Hikmat Bahadur Aidei13 August 2023He is god for us.Ran Singh Chauhan10 August 2023First of Thankyou very very much Dr for given to valuable tratement to my disease ankylosing spondylitis.. I suffering from last five years ankylosing spondylitis and I started tratement to dr last six months before. After tratement my body pain or stiffness are ok and I sleep on bed easily.... .Yashas Bhatt27 July 2023Dr Himanshu is very humble, Knowledgable and understanding doctor. I have went to him for my mothers treatment. At first when my mother went for her check up we thought it's gonna take a lot of time for my mother to get better as she was unable to walk and was on wheel chair, but when she got consultation from him and he made us understand what's the cause of it and started my mothers treatment and within a few days my mother started getting better and now she is able to walk also. Excellent doctor for Arthritis related diseases.Saurabh Agrawal21 July 2023I met Dr Aggarwal with my mother in law on 12th Aug 2022 on Friday. Her age is 78 years and 4 months and she is suffering from Rheumatoid Arthritis, Ankylosing Spondylitis , Asthma and Diabeties. But we went to Dr Aggarwal for the treatment of RA and AS. Personality and Characteristics: Dr is very young, smart, dynamic, humble, polite and very down to earth. Listening : His listen, every single problem shared by me and my Mother in law. She gave ample amount of time and understand the history. Diagnosed: He had seen all the past 5 years reports, Prescriptions which we were carrying at least for 10-15 mins . He did not ask us to do all the tests again those my last Dr conducted just 15 days back. He considered all tests and reports. Treatment: He had given some injections initially with oral tabs and ask to come weekly then by monthly after wards once it is required. Initial first or second week the pain and swelling of my mother in law had declined like anything. My in law started moving with the help of stick before that she was not able to move from the bed. This is the first line of faith developed in my and in law mind . You dnt believe it now almost 1 year completed and my mother in law is walking without stick easily. Her medications are limited and orally only. I again insist you to meet the Dr Aggarwal if you are or near one or dear one suffering from joint pain. Thank you Dr Aggarwal!