JUVENILE IDIOPATHIC ARTHRITIS IN NEW ZEALAND
Arthritis is often associated with older people but it can also affect children. Juvenile Idiopathic Arthritis (JIA) is defined as long-term (chronic) arthritis in one or more joints that begins before the age of 16 and lasts at least six weeks. It is thought that JIA affects around one in 1000 children in New Zealand. Children with JIA can experience pain, tiredness and difficulty in getting around. It is not known what causes JIA. In fact, the word idiopathic in the name actually means ‘of unknown origin’. Research suggests that some genes and environmental triggers, such as infection, may play a role in its development. JIA is not considered hereditary and rarely runs in families.
There are different types of JIA, two examples are systemic and polyarticular. Children who have systemic arthritis may experience fevers and rashes. This means they often have time off from school, which can lead to feeling isolated. Children who have polyarticular JIA have arthritis that affects five or more joints. Sometimes the neck, jaw joints and small joints in the hands and feet are affected.
If JIA is left untreated, or treatment fails to reduce symptoms, complications can occur. These can include growth problems, holes in the bones (erosions) and weak bones (osteopenia). The good news is that when JIA is correctly treated, most children will not experience complications, and some will outgrow their arthritis as they mature.
WHAT ARE THE SYMPTOMS?
JIA is a long-term (chronic) inflammatory condition caused when a child’s own immune cells attack their joints.
The signs and symptoms of JIA often change over time. In many cases, symptoms improve as the child gets older, and some children may become symptom free (full remission).
Most people have flexible joints. The ends of the bone inside joints are protected from wear and tear by healthy cartilage - a hard, shiny plastic-like material. Healthy cartilage is important, it keeps joints moving smoothly, and also helps muscles, tendons and ligaments do their jobs. Cartilage is also protected by synovial fluid that “oils” it and keeps it healthy. The joint is surrounded by a capsule with a thin smooth lining (the synovium) that keeps the fluid in place.
In JIA, the joint lining becomes inflamed and thickened, and synovial fluid may build up inside the capsule, which adds to the swelling. The inflamed joint lining may produce chemicals that damage the bone and cartilage in the joint. This inflammation of the joints (or of other parts of the body) can be painful, and sometimes disabling.
Symptoms may include:
- Pain, swelling or stiffness in the joints, especially in the mornings
- Loss of appetite or loss of weight
- Limping or a younger child may stop wanting to use their feet
- High fever and skin rash (systemic JIA)
- Swelling in the lymph nodes in the neck or other parts of the body
HOW IS IT DIAGNOSED?
JIA can be difficult to diagnose because the symptoms can differ between children, and they can appear like other childhood illnesses. If it is suspected, your doctor will refer your child to a specialist in juvenile arthritis.
- Take a detailed medical history of your child and the rest of the family
- Give your child a detailed physical examination – joints, reflexes and muscle strength
- Consider laboratory tests, like blood and urine
- Consider x-rays or other scans, such as MRI scans
Some tests may be repeated over time. This allows the specialist to track changes in your child’s symptoms. It is important to do this so the correct diagnosis is made. The specialist will then make sure your child receives the most appropriate treatment for the type of arthritis that they have.
There is currently no cure for JIA. However, with early diagnosis and effective treatment, a long-term break from symptoms (remission) is possible. Different treatments may aim to:
- Reduce pain and inflammation
- Lessen or prevent joint damage
- Keep joints as flexible as possible
Reducing inflammation and controlling pain will improve your child’s quality of life. Depending on your child’s particular case, the treatment plan may include:
Medication for pain and inflammation:
Non-steroidal anti-inflammatory drugs – or NSAIDs for short – can help to reduce the pain and stiffness associated with inflammation. They are usually taken after food to reduce the likelihood of an upset stomach. There are some people who shouldn’t take NSAIDs so you should check with your doctor or pharmacist before giving them to your child.
These drugs suppress the immune system and shut down the inflammatory process. The most commonly used example is prednisone. Steroids are generally used to bring the disease under control while waiting for other treatments to take effect. Steroids are used usually as short courses because of the risk of side effects from long-term use.
Disease Modifying Antirheumatic Drugs (DMARDs):
DMARDs including methotrexate, sulfasalazine and leflunomide, can be used to reduce the symptoms of inflammation, and can slow down disease progression and risk of damage in the long term. They are particularly effective if taken soon after your child’s symptoms first appear.
Biologic medicines are used when other medications have been tried but severe symptoms are still present. Medications like Enbrel are made from human proteins that get right to the source of the problem. Enbrel catches on to and inhibits a different protein already in your body called tumour necrosis factor (TNF), which is a naturally occurring chemical messenger in your bloodstream. Too much TNF often plays a part in causing the painful swelling and redness around your joints in rheumatological conditions. Enbrel works by blocking the effects of too much TNF, which means that it cannot start the process that leads to inflammation.
Other ways to control your symptoms:
Regular low-impact exercise eases pain and increases cardiovascular health. This can also provide an opportunity for children with JIA to meet other children, reducing feelings of isolation. Your child’s physiotherapist can advise on suitable exercises for your child.
Contact with other children who have JIA (support groups are listed below) can boost self-esteem. If JIA is a challenge for your child and your family, it may be helpful to be referred to a psychologist to learn ways to manage feelings, pain or relationships.
Some children with JIA may develop inflammation behind their eyes known as anterior uveitis. Because it is painless and doesn’t have any other symptoms, routine regular screening is important. Your child’s doctor or specialist will let you know how frequently your child will need eye checks. This is based on your child’s age and the type of arthritis they have. Some children will need to have more eye checks than others.
Healthy well-balanced diets are important for all children. There is limited evidence that increasing Omega 3 fats (found in fish) may help to reduce inflammation when used together with conventional medicines. Increasing your child’s calcium and vitamin D intake is important for their bone health, especially if they are taking certain medications such as steroids.
JIA doesn’t mean that your child can’t get on with their life. Arthritis New Zealand and Kids with Arthritis NZ have helped hundreds of children do just that.
Arthritis New Zealand
PO Box 10-020
Freephone 0800 663 463
Kids with Arthritis NZ
If you need further assistance with ENBREL administration, contact your healthcare professional, or call
0800 ENBREL (0800 362 735).