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Juvenile idiopathic arthritis (JIA), previously called juvenile rheumatic arthritis (JRA), is a chronic rheumatic disease that involves acute and chronic tissue inflammation of the joints and their supporting tissue in children and adolescents under the age of 16. JIA presents predominately in the peripheral joints and arthritis symptoms persist longer than 6 weeks. The etiology of JIA is not known, although variables thought to be important in the pathophysiology of the disease include genetic predisposition, unknown environmental triggers, and immune reactivity to infection.

Prevalence and Course

The prevalence of JIA is estimated from between 4 to 150 cases per 100,000 children worldwide. It is estimated that there are approximately 300,000 children with JIA in the USA.
JIA encompasses seven subtypes of arthritis including oligoarticular JIA, seropositive polyarticular JIA, seronegative polyarticular JIA, systemic-onset JIA, enthesitis-related arthritis, juvenile psoriatic arthritis, and undifferentiated JIA.

Inflammation of the joints and chronic pain are the primary clinical manifestations of JIA. The majority of children report mild but frequent pain, with approximately 8–14% of children experiencing a more severe disease course and worse quality of life. Joint inflammation and pain can persist into adulthood.

Health and Psychosocial Consequences

Children with JIA have an increased risk for impaired physical functioning, school absences, overall adjustment problems, and anxious and depressive symptoms. However, most children with JIA are similar to healthy peers in terms of self-concept, self-esteem, perceived competence, body image, social competence, social support and psychological functioning.

Evidence-based Assessment

Domains of assessment relevant for children with JIA include pain characteristics, physical, social, emotional, and family functioning, and health habits. A variety of evidence-based assessment tools are available such as the Pediatric Quality of Life Rheumatology, Juvenile Arthritis Quality of Life Questionnaire, and Paediatric Rheumatology Quality of Life Scale.

Culture, Diversity, Demographic and Developmental Factors

Although children from all ethnic backgrounds can develop JIA, it is most common in Caucasians. Overall, girls develop JIA more frequently than boys. The most frequent form of JIA (oligoarticular) is more common in toddlers than in older children. Despite equivalent levels of healthcare utilization, patients of racial and ethnic minority, and those of lower socioeconomic background tend to experience worse outcomes. 

Evidence-based Interventions

The aim of treatment is multidimensional and includes controlling pain, preserving range of motion/muscle strength, disease remission, managing systemic complications and facilitating normal physical and psychosocial development. Research supports the efficacy of multimodality medical treatment, physical/exercise therapy, and psychological therapies. Cognitive-behavioral interventions, including relaxation, biofeedback, and multicomponent interventions are shown to be effective for pain reduction in children with JIA musculoskeletal pain.

Resources

• American College of Rheumatology. https://www.rheumatology.org/
• Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/juvenile-idiopathic-arthritis-jia/what-is-juvenile-idiopathic-arthritis.php

Authors: Cindy Karlson, PhD

Date of last update: May, 2019

References

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