Juvenile idiopathic arthritis

Juvenile idiopathic arthritis

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It is generally accepted that rheumatic diseases (arthropathies - joint diseases) apply only to adults, in particular to the elderly. In fact, however one in ten ill adults manifested the first symptoms of arthropathy as early as childhood (before 16 years of age). Hence, both parents and pediatricians should be particularly sensitive to first symptoms of these diseases (especially juvenile idiopathic arthritis, which is the most common arthropathy among pediatric patients).

Juvenile idiopathic arthritis - the most common childhood arthropathy

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases whose common denominators are:

  • Arthritis - the affected joints are swollen, excessively warmed compared to healthy and painful joints, and their mobility is significantly reduced. Most often, the disease process includes knee, wrist and ankle joints.
  • Atrophy and weakness of the muscles adjacent to the affected joint - this is associated with significant impairment in the functioning of the affected limb and requires intensive rehabilitation.
  • Morning stiffness - occurs immediately after waking up and most often affects the neck and upper limbs. In the youngest children, it can be very difficult to capture by parents and a doctor.
  • Subcutaneous nodules - Only occur in 5 to 10 percent of children with juvenile idiopathic arthritis. They are most often located on the straight parts of the forearms and on the occiput. In some patients, they may be the first manifestation of a developing disease.
  • Non-statutory changes - in the course of JIA, uveitis, pericardium (the membrane surrounding the heart) or pleura (the membrane surrounding the lungs) may occur. For the generalized form of the disease are characteristic enlargement of the liver, spleen and lymph nodes, high fever and polymorphic (variable shape), salmon skin rash.
  • Duration over 6 weeks - this is one of the criteria for the diagnosis of juvenile idiopathic arthritis.
  • Unknown etiology - until today it has not been possible to determine exactly the cause of JIA. We only know that the underlying disease is autoimmune process (the body produces antibodies against its own healthy tissues) and it develops in people with a certain genetic predisposition.

Of course, similar symptoms may occur in the course of many other diseases (including reactive arthritis in the course of streptococcal infection, as well as hemophilic and leukemic arthropathy). Therefore, the diagnosis of JIA should be preceded by a whole package of laboratory and imaging tests excluding other causes of child joint changes.

Juvenile idiopathic arthritis - how often does it occur?

As we mentioned before, JIA is the most common childhood arthropathy. The incidence rate in the European population is estimated to be 2.6-20 / 100 thousand / year. It gives us from about 140 to 1,400 new cases a year. Slightly more frequent occurrence of the disease among girls is observed.

Juvenile idiopathic arthritis - treatment

Juvenile idiopathic arthritis is chronic disease. Hence her treatment is long-term, multi-drug (non-steroidal anti-inflammatory drugs and light immunosuppressants are used - which suppress the child's immune system) and should be managed by a specialized pediatric rheumatology center in cooperation with a pediatrician who deals with the child on a daily basis. It is also very important to properly educate parents who undoubtedly take an active part in the treatment of their child.

Parallel to pharmacological treatment should be carried out regular rehabilitation under the guidance of an experienced physiotherapist. This is to improve the comfort of a small patient's life and to prevent his permanent disability resulting from permanent joint deformities and muscular atrophy.

Juvenile idiopathic arthritis - prognosis

Prognosis in JIA should be very cautious. The disease is chronic and despite the fact that remission is obtained, it is prone to frequent relapses. Nevertheless, effective pharmacotherapy, parental support and regular rehabilitation can allow a sick child to lead a relatively normal life at both home and peer levels.

The problem of rheumatic diseases in children is often underestimated. However, this is a huge mistake, because their early diagnosis and the introduction of appropriate therapy is a chance for sick children to lead a relatively normal life.

Bibliography:Pediatrics by Wanda KawalecInternal Szczeklik 2017/18