Juvenile idiopathic arthritis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Juvenile idiopathic arthritis (JIA) describes a group of chronic pediatric inflammatory arthritides. There are several subtypes, including oligoarticular, polyarticular, and systemic onset.
Affects 1 in 1000 children and can present at any age.
Diagnosis is made clinically. Laboratory and radiographic testing provide classification and prognostic information but are not diagnostic.
The primary goals of treatment are to relieve immediate pain and prevent joint damage and therefore disability. Intra-articular corticosteroids offer good control if only a few joints are affected. Methotrexate is the most commonly used conventional synthetic disease-modifying antirheumatic drug. Physical therapy, occupational therapy, and psychology form an important aspect of management.
Around 10% to 20% of children with JIA are at risk of developing anterior uveitis. All children with a diagnosis of JIA must undergo regular ophthalmologic examinations to detect and manage inflammation.

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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Davies K, Cleary G, Foster H, et al. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford). 2010 Jul;49(7):1406-8.[Abstract][Full Text]
Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011 Apr;63(4):465-82.[Abstract][Full Text]
Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: recommendations for nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Arthritis Care Res (Hoboken). 2022 Apr;74(4):505-20.[Abstract]
Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2022 Apr;74(4):521-37.[Abstract]

Other Online Resources

Arthritis Foundation: juvenile idiopathic arthritis
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): juvenile arthritis

Referenced Articles

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59. Davies K, Cleary G, Foster H, et al. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford). 2010 Jul;49(7):1406-8.[Abstract][Full Text]
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64. Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol. 2010 Mar;22(2):213-7.[Abstract]
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77. Burgos-Vargas R, Tse SM, Horneff G, et al. A randomized, double-blind, placebo-controlled multicenter study of adalimumab in pediatric patients with enthesitis-related arthritis. Arthritis Care Res (Hoboken). 2015 Nov;67(11):1503-12.[Abstract][Full Text]
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97. Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2022 Apr;74(4):521-37.[Abstract]
98. Schulert GS, Yasin S, Carey B, et al. Systemic juvenile idiopathic arthritis-associated lung disease: characterization and risk factors. Arthritis Rheumatol. 2019 Nov;71(11):1943-54.[Abstract][Full Text]
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100. Sura A, Failing C, Sturza J, et al. Patient characteristics associated with response to NSAID monotherapy in children with systemic juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2018 Jan 5;16(1):2.[Abstract][Full Text]
101. Tarp S, Amarilyo G, Foeldvari I, et al. Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis: a systematic review and meta-analysis of randomized trials. Rheumatology (Oxford). 2016 Apr;55(4):669-79.[Abstract][Full Text]
102. Ruperto N, Brunner HI, Quartier P, et al; PRINTO; PRCSG. Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012 Dec 20;367(25):2396-406.[Abstract][Full Text]
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105. Brunner HI, Quartier P, Alexeeva E, et al. Efficacy and safety of canakinumab in patients with systemic juvenile idiopathic arthritis with and without fever at baseline: results from an open-label, active-treatment extension study. Arthritis Rheumatol. 2020 Dec;72(12):2147-58.[Abstract]
106. De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012 Dec 20;367(25):2385-95.[Abstract][Full Text]
107. Song GG, Lee YH. Comparison of the efficacy and safety of biological agents in patients with systemic juvenile idiopathic arthritis: a Bayesian network meta-analysis of randomized controlled trials. Int J Clin Pharmacol Ther. 2021 Mar;59(3):239-46.[Abstract]
108. Ruperto N, Quartier P, Wulffraat N, et al. A phase II, multicenter, open-label study evaluating dosing and preliminary safety and efficacy of canakinumab in systemic juvenile idiopathic arthritis with active systemic features. Arthritis Rheum. 2012 Feb;64(2):557-67.[Abstract][Full Text]
109. Lovell DJ, Giannini EH, Reiff AO, et al. Long-term safety and efficacy of rilonacept in patients with systemic juvenile idiopathic arthritis. Arthritis Rheum. 2013 Sep;65(9):2486-96.[Abstract][Full Text]
110. Guzman J, Kerr T, Ward LM, et al. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J. 2017 Aug 22;15(1):68.[Abstract][Full Text]
111. Schulert GS, Minoia F, Bohnsack J, et al. Effect of biologic therapy on clinical and laboratory features of macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2018 Mar;70(3):409-19.[Abstract][Full Text]
112. Ter Haar NM, van Dijkhuizen EHP, Swart JF, et al. Treatment to target using recombinant interleukin-1 receptor antagonist as first-line monotherapy in new-onset systemic juvenile idiopathic arthritis: results from a five-year follow-up study. Arthritis Rheumatol. 2019 Jul;71(7):1163-73.[Abstract][Full Text]
113. Quartier P, Alexeeva E, Constantin T, et al. Tapering canakinumab monotherapy in patients with systemic juvenile idiopathic arthritis in clinical remission: results from a phase IIIb/IV open-label, randomized study. Arthritis Rheumatol. 2021 Feb;73(2):336-46.[Abstract][Full Text]
114. DeWitt EM, Kimura Y, Beukelman T, et al. Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2012 Jul;64(7):1001-10.[Abstract][Full Text]
115. Foeldvari I, Wierk A. Effectiveness of leflunomide in patients with juvenile idiopathic arthritis in clinical practice. J Rheumatol. 2010 Aug 1;37(8):1763-7.[Abstract][Full Text]
116. Ramanan AV, Quartier P, Okamoto N, et al. Baricitinib in juvenile idiopathic arthritis: an international, phase 3, randomised, double-blind, placebo-controlled, withdrawal, efficacy, and safety trial. Lancet. 2023 Aug 12;402(10401):555-70.[Abstract]
117. ClinicalTrials.gov. Efficacy study of tofacitinib in pediatric JIA population. NCT02592434. April 2020 [internet publication].[Full Text]
118. Brunner HI, Ruperto N, Tzaribachev N, et al. Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis: results of a multicentre, double-blind, randomised-withdrawal trial. Ann Rheum Dis. 2018 Jan;77(1):21-9.[Abstract][Full Text]
119. Ilowite NT, Prather K, Lokhnygina Y, et al. Randomized, double-blind, placebo-controlled trial of the efficacy and safety of rilonacept in the treatment of systemic juvenile idiopathic arthritis. Arthritis Rheumatol. 2014 Sep;66(9):2570-9.[Abstract][Full Text]
120. American College of Rheumatology. 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases. Feb 2023 [internet publication].[Abstract][Full Text]
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