Signs & Symptoms | juvenilearthritis

Signs and Symptoms of JIA

Onset of JIA

Most commonly, onset of symptoms occurs between the age of 2-4, although it can develop anytime throughout childhood and the teen years. [1] It is more common in females. [1]

The first things parents will notice are:

Their child will have morning stiffness for an hour or more after waking up. This same stiffness may occur after the child has taken a nap, or has been sitting or lying down for a prolonged period of time. [2]
Their child uses avoidant postures to favor their sore joints, or their child may start limping or being more clumsy. [2]

Your child might have difficulty verbalizing that they are having joint pain, especially if your child is very young. They may describe the pain by saying that they "feel sick" or "feel bad". [3] JIA is often mistaken for growing pains but when it is persistent and accompanied by a fever, this is a sign that it is not just normal growing pains. [3]

It is important for parents to monitor any changes in the child's activities.

Early Signs of JIA

Main Symptom: Joint Swelling

Details of Joint Swelling

The lining of the joint (also known as the "synovial membrane") becomes inflamed. [4]
The fluid in the joint (also known as "synovial fluid") accumulates, leading to pain and lack of motion. [4]
The cartilage and child's bones begin to break down.
Lack of cartilage leads to abnormal bone growth.

Accompanied by joint pain and tenderness. [5]
Joint stiffness, and redness or a feeling of warmth around the joint.
This inflammation can result in a limited range of motion, especially in the morning. [5]
Pain is typically mild to moderate. [6]
Joint swelling can lead to destruction of soft and hard tissues in the joint, and when left untreated, can cause irreversible damage. [5]

Other Symptoms

Constant high fevers
Rashes, which usually occur with the fever
Tiredness
Uveitis (eye swelling and vision problems)
Eating difficulties and loss of appetite
Jaw pain
Weight loss

Progression of JIA

JIA is a chronic condition and usually persists into adulthood.

Throughout the course of this disability, the child's symptoms will likely fluctuate, which can make it feel like a rollercoaster of ups and downs.

Sometimes symptoms may disappear altogether, also known as remission. Approximately 40-60% of children enter periods of remission. [7]
However, they may also go through periods of time when symptoms gets worse, also known as "flare ups". Children may have only one or two flare ups or they can have many flare ups throughout the course of the disability. [7]
It is important to remember that every child is different and will experience symptoms differently.

Effects of JIA In Adulthood

Duration of JIA

This disability starts during childhood when the bones, and joints are still developing.

If left untreated:

The child may not reach motor milestones. [8]
The child may have slow or uneven bone and joint growth, leading to permanent joint damage and disfiguration.
In adulthood, overall height tends to be shorter in individuals who had JIA. [8]
Adults who had JIA may have an overbite or poor mouth opening due to damage in the joints of the jaw, this can lead to dental problems later in life due to difficulty brushing teeth and flossing. [8]
Vision loss is relatively common in adults who have had JIA due to uveitis. Some adults may need surgery to correct joint deformities. [8]
Adults who had JIA are at a much higher risk of osteoporosis and osteoarthritis in their older years. [8]

The most common type of JIA, Oligoarthritis, has the best outcomes, and highest rate of remission for children into adulthood.

Disorders that May Co-Occur with JIA

The following conditions are associated with arthritis in children [9]:

Diabetes
Heart Disease
Insomnia (sleep problems)

Kidney Disease
Depression & Anxiety
Under nutrition or Obesity

Glossary

Cartilage: A firm, elastic tissue that protects the ends of the bone at the joint

Remission: A period of time (that can last a few days to years), where a person's symptoms, like joint pain and swelling, become less severe, or even disappear altogether. Remission can occur from medications, or aggressive treatment, or for unknown reasons.

"Flare Up": A temporary period of time where there is a sudden worsening of symptoms. Flare Ups usually are unpredictable, cause a lot of joint pain and swelling, and can impact every day activities.

References

1. Angelo Ravelli, and Alberto Martini, "Seminar: Juvenile Idiopathic Arthritis," The Lancet 369, no. 9563 (2007): 767-778.

2. Renee Modica, Sukesh Sukuaran, and Diana Milojevic, "Pediatric Musculoskeletal Examination for Juvenile Arthritis," Pediatric Annals 41, no. 11 (2012): 1-14.

3. Ellen Mosley, "Personal Practice: Practical Guide to Treating Children with Juvenile Idiopathic Arthritis," Pediatrics and Child Health 25, no. 12 (2015): 587-591.

4. "What is Rheumatoid Arthritis," Arthritis Foundation, accessed March 10, 2017, http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php

5. S. Abramowicz, S. Kim, S. Prahalad, A.F. Chouinard, and L.B. Kaban, “Review Paper: Juvenile Arthritis: Current Concepts in Terminology, Etiopathogenesis, Diagnosis, and Management,” International Journal of Oral & Maxillofacial Surgery 45, no. 7 (2016): 801-812.

6. L. E. Schanberg, K. K. Anthony, K. M. Gil, and E.C. Maurin, "Daily Pain and Symptoms in Children with Polyarticular Arthritis," Arthritis and Rheumatism 48, no. 5 (2003): 1390-1397.

7. J. C. Packham, and M. A. Hall, "Long‐term Follow‐up of 246 Adults with Juvenile Idiopathic Arthritis: Functional Outcome," Rheumatology 41, no. 12 (2002): 1428-1435.

8. "Juvenile Idiopathic Arthritis Symptoms & Causes," Boston Children's Hospital, accessed March 11, 2017, http://www.childrenshospital.org/conditions-and-treatments/conditions/juvenile-idiopathic-arthritis/symptoms-and-causes

9. "Comorbidities," Centers for Disease Control and Prevention, accessed March 9, 2017, https://www.cdc.gov/arthritis/data_statistics/comorbidities.htm