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?

Based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS), juvenile arthritis is estimated to affect around 1 child in every 1,000 aged 0–15 [1]. However, the number of cases of juvenile arthritis is difficult to estimate because is it an uncommon condition and this estimate has a wide margin of error.

Treatment and management of juvenile arthritis

Based on the AIHW National Hospital Morbidity Database (NHMD), in 2016–17, there were 15,096 hospitalisations for children aged 0–15 with the principal diagnosis of musculoskeletal conditions (2.1% of all hospitalisations for this age group). Juvenile arthritis accounted for nearly 8.5% of these hospitalisations (with a total of 1,276 hospitalisations).

Juvenile arthritis is more common in girls than boys [2]. In 2016–17, the hospitalisation rate for girls (35 per 100,000 population) was 2 times that of boys (17 per 100,000 population) (Figure 1). From 2006–07 to 2016–17 hospitalisation rates for juvenile arthritis increased from 14 to 26 per 100,000 population.

Figure 1: Rate of hospitalisation for juvenile arthritis, children aged 0–15, by sex, 2006–07 to 2016–17

The line chart shows that in the 10 years from 2006–07 to 2016–17 the hospitalisation rates (per 100,000 population) for juvenile arthritits in children aged 0–15 increased for both boys (from 8 to 17 years) and for girls (from 21 to 35).

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

Treatment options 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.

Medication

Medicines recommended to manage the pain and inflammation associated with juvenile arthritis are paracetamol, codeine, and non-steroidal anti-inflammatory drugs (NSAIDs). Disease-modifying anti-rheumatic drugs (DMARDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) are specialised immunosuppressant medications that alter disease progression.

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 with parents with children without the condition [7].

References

  1. ABS (Australian Bureau of Statistics) 2018. National Health Survey: First Results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
  2. Ravelli A & Martini A 2007. Juvenile idiopathic arthritis. The Lancet 369:767–776.
  3. Lundberg V, Lindh V, Eriksson C, Petersen S & Eurenius E 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, Cattalini M, Oggiano S, Fazzi E 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, Hassani A, Chkirate B, Amine B et al. 2013. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatrics 13(2).
  6. Arthritis Care 2011. My child has arthritis: A practical guide for parents. Arthritis Care. London UK.
  7. Toupin-April KT, Cavallo S, Feldman DE & Ni A 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.