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Juvenile rheumatoid (idiopathic) arthritis

Juvenile idiopathic arthritis (JIA)

Juvenile idiopathic arthritis (JIA), sometimes called juvenile rheumatoid arthritis or juvenile chronic arthritis, is a childhood disease that causes inflamed, swollen joints that are often stiff and painful. Symptoms common to all forms of JIA include joint pain, a disturbance in the way a child walks (abnormal gait), and joint stiffness that lasts longer than 1 hour in the morning.

The cause of JIA is not well understood. Most experts believe it is caused by a combination of factors, including an overly active immune system.

There are several types of JIA. Each type is based on how many joints are affected during the first 6 months of active disease, whether the child has other symptoms, and which parts of the body are affected.

  • Oligoarticular JIA (oligoarthritis) is the most common type of JIA. In this type, 1 to 4 joints are affected in the first 6 months of the disease. If 4 or fewer joints continue to be affected, it is called persistent oligoarthritis. If more joints become affected after 6 months, it is called extended oligoarthritis.
  • Polyarticular JIA (polyarthritis) is the second most common type. Children with this type have 5 or more joints affected in the first 6 months of the disease.
    • If an antibody called rheumatoid factor is present in the blood, the polyarthritis is rheumatoid factor-positive (RF-positive).
    • If the rheumatoid factor antibody is not present, the polyarthritis is rheumatoid factor-negative (RF-negative).
  • Systemic JIA can cause whole-body symptoms, such as fever and rash.
  • Enthesitis-related JIA can affect joints and also entheses (the areas where tendons and ligaments attach to the bones).
  • Psoriatic JIA can combine joint pain and swelling with a skin condition called psoriasis.
  • A few children are said to have unclassified JIA. This means that their symptoms and past health do not exactly match any of the other types of JIA.

Several types of JIA can also include serious eye inflammation.

  • Symptoms

    Rheumatoid Arthritis Zones

    Picture of the common sites for rheumatoid arthritis

    Rheumatoid arthritis often affects small and large joints on both sides of the body (symmetry), such as both hands, both wrists or elbows, or the balls of both feet.

  • Treatment

  • Caring for your child

    Caring for your child with juvenile idiopathic arthritis (JIA)

    You can do a lot at home to help your child relieve his or her symptoms and prevent JIA from causing problems.

    • Do range-of-motion exercises.

      These help maintain your child's joint range and muscle strength. They also prevent contractures. You may need to help an infant or younger child do the exercises.

    • Find a balance between rest and activity.

      Your child may need extra naps or quiet time to rest the joints and regain strength. But too much rest may lead to weakness in unused muscles.

    • Follow a medicine schedule.
      • An older child may find it easier to remember to take medicine by using a pillbox or chart for a day's or week's worth of medicine.
      • Ask your doctor if the dose can be adjusted so your child can take it at times that are most convenient and won't make him or her feel "different" from others.
      • To avoid stomach upset, you can also give nonsteroidal anti-inflammatory drugs (NSAIDs) with meals or a small snack.
    • Use assistive devices.

      These can help your child hold on to, open, close, move, or do things more easily. Devices include Velcro fasteners and enlarged handles. Getting your child lightweight clothing and toys will also help.

    • Make sure that your child sees the doctor regularly.

      Your child should also have eye exams with an ophthalmologist. Inflammatory eye disease can develop as a complication in children with JIA.

    • Help manage your child's stiffness.
      • Apply heat to stiff and painful joints for 20 minutes, and repeat as needed. You can use hot water bottles. Or make hot packs from towels dipped in warm water or wet towels microwaved for 15 to 30 seconds. Always make sure that hot water bottles and hot packs aren't too hot for your child's skin. Keep a cloth between the hot water bottle and your child's skin. Don't use heat if your child's joints are red and warm.
      • Many children who have JIA have less stiffness in the morning if their joints are kept warm during the night. To help keep joints warm, try footed pajamas, thermal underwear, a sleeping bag, a heated water bed, or an electric blanket.
      • Encourage your child to take a warm bath or shower first thing in the morning. It can help ease stiffness. Have your child stretch gently afterward.
      • Give morning medicines as early as you can, with a snack or breakfast, to prevent upsetting an empty stomach.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.