Juvenile Idiopathic Arthritis
Managing and Treating JIA
There is no cure for JIA, but it CAN be managed and treated.
The type of treatment provided depends on the severity of the child’s symptoms
and whether the child is experiencing a “flare up”.
Treatment plans are prescribed by a health care team and usually involve a combination of medication, exercise, eye care, and maintenance of a healthy diet. Management should not only rely on medication. Children with JA should be prescribed regular exercise plans, remain active in their social activities, and may receive therapy from an occupational therapist or physiotherapist.
Goals of Treatment
The main goal of treatment is to reduce swelling in joints, control pain, and help the child to experience normal growth and development, without long-term negative effects. [1]
The other main goal is to help the child achieve remission. [1]
Remission is defined as having no active disease, meaning that there is no active arthritis in the joints, no fevers/rashes or any other symptoms associated with JIA.
Medication
Anti-Inflammatory Medications (such as Advil and Aleve)
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Taken 3-4 times a day, with a prescribed dose from a doctor [1]
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Beneficial for a child who has less severe symptoms
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Usually within 1 month, the child will notice improvements with morning stiffness, joint pain and will have increased activity [1]
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Often not strong enough for more severe cases of JIA so it may be used along with other medications [1]
Corticosteroids
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Taken orally or by injection to the affected joint [2]
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Taking anti-inflammatory medications and steroid medications are beneficial for children who have severe symptoms [2]
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These are often used particularly for "flare ups"
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Side effects include weight gain/loss, nausea, and stomachaches [2]
Anti-Rheumatic Medications (such as Methotrexate)
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Taken orally or injected [3]
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Used as a stronger method for more severe types of JIA, when other types of medication do not work
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Used to improve joint swelling in the jaw and spine [3]
- Also used to improve vision problems associated with JIA [3]
- Strong side effects including nausea and vomiting [3]
Occupational Therapy and Physiotherapy
Both occupational therapists and physiotherapists can help the child with their every day tasks and work to improve the child’s quality of life.
Occupational therapists focus on hand and finger functioning, such as grasping or writing, which are the small joints that are sometimes affected. They work to help children with JIA with their daily activities by modifying some of the ways they may dress, eat, bathe and play. [2]
Physiotherapists will determine the child’s physical limitations and work on range of motion, coordination, and strengthening muscles, sometimes with the use of adaptive equipment like a brace. [2]
Eye Care
One of the most severe symptoms of JIA is inflammation in the eye.
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About 12% of children with JIA have swelling in the uvea, which is the middle layer of the eye. [4]
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It is important to manage the swelling, so that the child does not develop cataracts, or risk losing their sight.[4]
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The child should visit an ophthalmologist regularly, and may be prescribed steroid drops to take daily. [4]
Maintaining a Healthy Diet
JIA is associated with under nutrition, due to reduced food intake. [5]
Often children with JIA have joint pain in their jaw and may not be able to open their mouth fully. [5] Children may not have appetite due to side effects from the medications they are taking, such as nausea and stomachaches. [5] This can lead to further issues like anemia, stunted growth, and osteoporosis. [5] Without proper nutrients, the child's energy may also suffer, impacting physical activities.
To ensure your child receives proper nutrition:
- keep meal sizes smaller and more frequent when your child is experiencing medication side effects [6]
- incorporate foods that do not require a lot of chewing, such as soups, healthy smoothies, oatmeal, and yoghurt
- include foods high in Vitamin D, which is found naturally in oily fish and eggs
- stay away from sugary, processed foods that do not have much nutritional benefit [6]
- when you child is hungry, make sure they are eating calorie-dense foods, found in whole grains, olive oil, peanut butter [6]
- get creative to help make eating fun!
Foods High in Vitamin D
For creative kid-friendly recipes
Glossary
Corticosteroids: Steroid medications that are meant to quickly reduce swelling. They are often used in treatment plans for arthritis
Methotrexate: Medication used to treat severe arthritis by suppressing the immune system. It is usually given when other medications have been tried first but are not effective.
Cataracts: A clouding of the lens of the eye, resulting in difficulty with vision
Anemia: A condition that causes tiredness and dizziness, resulting from a lack of iron in the diet
Osteoporosis: A condition where bones become brittle and easily broken, sometimes due to a lack of calcium or Vitamin D in the diet
References
1. S.H. Abd-Allah, A.S. El-Shal, S.M. Shalaby, H.F. Pasha, A.M. Abou El-Saoud, S.M. Abdel Galil, and T.A. Mahmoud, “Influence of Matrix Metalloproteinase 1 and 3 Genetic Variations on Susceptibility and Severity of Juvenile Idiopathic Arthritis,” IUBMB Life 67, no. 12, (2015): 934-942.
2. Rebecca James, and Lucy Wedderburn, "Modern Management of Juvenile Idiopathic Arthritis," Prescriber 27, no. 6 (2016): 37-43.
3. Timothy Gower, "Methotrexate: Managing Side Effects," Arthritis Foundation, accessed March 8, 2017, http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/disease-modifying-drugs/methotrexate-side-effects.php
4. Madeleine Hawkins, Andrew Dick, Richard Lee, Athimalaipet Ramanan, Ester Carreno, Catherine Guly, and Adam Ross, "Managing Juvenile Idiopathic Arthritis - Associated Uveitis," Survey of Ophthalmology 61, no. 2 (2016): 197-210.
5. A. Cleary, G. Lancaster, F. Annan, J. Sillis, and J. Davidson, "Nutritional Impairment in Juvenile Idiopathic Arthritis," Rheumatology 43, no. 12 (2004): 1569-1573.
6. Debbie Lewis, "Diet and JIA," Juvenile Idiopathic Arthritis, May 11, 2015, http://www.jia.org.uk/diet-and-jia