What is juvenile arthritis?

Juvenile arthritis (also known as juvenile idiopathic arthritis) is a general term used to describe inflammatory arthritis in children that begins before the 16th birthday and lasts at least 6 weeks.

Children with juvenile arthritis are mostly affected in just one or a few joints. Typically, joints involving long bones (such as the knees, elbows, wrists and ankles) are affected. Some children are also affected in areas other than joints such as the eyes, skin or other body tissues.

If not properly treated, juvenile arthritis can affect a child's growth and development, causing joint damage, growth abnormalities and permanent disability.

Signs and symptoms

The impact of juvenile arthritis varies from child to child, and even from day to day in the same child. Joint stiffness and pain may be mild one day but the next day so severe that the child has difficulty moving or is unable to move at all. Typically juvenile arthritis has an unpredictable pattern of activity, where periods without symptoms are followed by a sudden reappearance of signs and symptoms known as 'flare-ups'.

How many children have juvenile arthritis?

The number of cases of juvenile arthritis is difficult to estimate because is it an uncommon condition. Based on self-reported data from the Australian Bureau of Statistics (ABS) 2014–15 National Health Survey (NHS), juvenile arthritis is estimated to affect at least one child in every 1,000 aged 0–15.

Research suggests that more girls suffer from juvenile arthritis than boys [1].

Treatment and management

The treatment used for juvenile arthritis varies according to the type of disease. A multidisciplinary team (such as a GP, rheumatology consultant, specialist nurse, occupational therapist, physiotherapist, podiatrist, ophthalmologist and orthopaedic consultant) is required for the correct treatment and management of this condition. Children with severe cases sometimes need to be hospitalised.

Hospitalisations

Based on the AIHW National Hospital Morbidity Database (NHMD), in 2014–15, there were 14,820 hospitalisations for children aged 0–15 with the principal diagnosis of musculoskeletal conditions (1.7% of all hospitalisations for this age group). The largest number of these hospitalisations (1,497) was for the treatment for juvenile arthritis.

Treatment option for juvenile arthritis in hospital

Splints: Medical devices can be used to restrict movement in the arm, leg or spine. Splints may be worn to protect damaged joints and to minimise further damage.

Pain management: Aside from taking medications, there are other strategies that can be used to manage pain during procedures and everyday life. These may include relaxation, deep breathing, distraction from pain, and education regarding strategies for dealing with and thinking about pain.

Joint injections: Medications can be injected directly into the joint. These medications are usually corticosteroids, which are anti-inflammatory drugs that slow down the accumulation of cells that cause inflammation.

Joint aspiration: This procedure collects fluid from the joint to determine if there is infection. Alternatively, it can be used to drain a swollen joint to relieve pain and improve mobility.

Joint replacement: This procedure replaces damaged joint structures with artificial components.

Source: AIHW 2013.

In 2014–15, the hospitalisation rate for girls (40 per 100,000 population) was 1.7 times that of boys (23 per 100,000 population). This could be due to juvenile arthritis being more common in girls than boys [1].

Figure 1: Rate of hospitalisation for juvenile arthritis, children aged 0–15, by sex, 2005–06 to 2014–15

The line chart shows that in the 10 years from 2005–06 to 2014–15 the hospitalisation rates for juvenile arthritis in children aged 0–15 increased from 14 to 32 per 100,000 population. The increase was greater in girls than boys.

Source: AIHW National Hospital Morbidity Database (Data table).

In the 10 years to 2014–15:

  • hospitalisation rates for juvenile arthritis increased from 14 to 32 per 100,000 population.
  • There was a rise of 170% in the administration of drug treatments (pharmacotherapy), 118% rise in allied health interventions, 98% rise in joint injections (primarily for corticosteroids) and a 25% rise in joint aspiration.

Medication

Medicines recommended to manage the pain and inflammation associated with juvenile arthritis are paracetamol, codeine, and non-steroidal anti-inflammatory drugs (NSAIDs). Stronger medications such as disease-modifying anti-rheumatic drugs (DMARDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) may be prescribed when insufficient symptom control is obtained by paracetamol, codeine or NSAIDs.

DMARDs and bDMARDs are specialised immunosuppressant medications that alter the disease progression. Since 2003, the availability of bDMARDs has broadened the treatment options for juvenile arthritis [2].

Quality of life

Children with juvenile arthritis and their families can be severely affected by the treatment and limitations resulting from juvenile arthritis. Children with severe juvenile arthritis can have a lower health-related quality of life, with the disability and pain affecting their physical and social wellbeing [3]. These children may also exhibit emotional difficulties and a delay of psychological development leading to low self-esteem, a distorted self-image, and more anxiety and depression than their peers [4]. Older children may experience several activity limitations at school, ranging from complete inability to attend school or inability to participate in school activities (such as difficulty in sitting, writing, participating in sports etc.) [5, 6].

In some cases, caring for a child with juvenile arthritis may place considerable demands on parents and carers. They may experience financial hardship and psychological distress compared to parents with children without the condition [7].

References

  1. Ravelli A & Martini A 2007. Juvenile idiopathic arthritis. The Lancet 369:767–776.
  2. AIHW (Australian Institute of Health & Welfare) 2013. A snapshot of juvenile arthritis, January 2013. Bulletin no. 113. Cat. no. AUS 168. Canberra: AIHW.
  3. Lundberg V, Lindh V, Eriksson C et al. 2012. Health-related quality of life in girls and boys with juvenile idiopathic arthritis: self and parent reports in cross-sectional study. Pediatric Rheumatology 10:33–40.
  4. Bomba M, Meini A, Molinaro A et al. 2013. Body experiences, emotional competence, and psychosocial functioning in juvenile idiopathic arthritis. Rheumatology International 33 (8):2045–2052.
  5. Bouaddi I, Rostom S, Badri DE et al. 2013. Impact of juvenile idiopathic arthritis on schooling.
  6. Arthritis Care 2011. My child has arthritis: A practical guide for parents. Arthritis Care. London UK.
  7. April KT, Cavallo S, Feldman DE et al. 2012. The associations among economic hardship, caregiver psychological distress, disease activity, and health-related quality of life in children with juvenile idiopathic arthritis. Quality of Life Research 21 (7):1185–1191.