Juvenile Arthritis

Juvenile idiopathic arthritis (JIA) is chronic arthritis that affects approximately 1 in every 1,000 children. JIA affects children less than 16 years of age. It is not usually inherited. JIA may affect one or many joints. Children with JIA may also have silent eye inflammation, fevers, or rash. Systemic onset JIA may affect many joints and organs. Oligoarticular JIA occurs in half of all children with JIA. It affects fewer than five joints and occurs more often in girls. Polyarticular JIA affects five or more joints. Other forms of JIA include juvenile psoriatic arthritis and enthesis-related arthritis, which affects the spine.

What Are the Signs/Symptoms?

Children with JIA may have joint pain and swelling. Signs also include limping, morning stiffness, reluctance to use an arm or leg, reduced activity, and difficulty with fine motor activities. Children with systemic onset JIA often have repeating, high fevers and a pink rash that comes and goes. Oligoarticular JIA raises the risk of eye inflammation (uveitis) and regular eye exams from an ophthalmologist are needed for screening. Signs of juvenile psoriatic arthritis are nail changes and swollen digits. Enthesis-related arthritis may cause back pain and stiffness. Diagnosis of JIA is based on a physical exam and medical history. Lyme disease, infection, childhood cancer, and other causes must be ruled out first.

What Are Common Treatments?

A pediatric rheumatologist should lead the treatment and management of JIA. Goals of treatment are to control symptoms, improve function and prevent joint damage. If only a few joints are affected, a steroid injection into the joints may ease pain and swelling. Low-dose, short-term oral corticosteroids, such as prednisone, may be used in some situations. When many joints are involved or steroid injections fail to work, disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex) or leflunomide (Arava), may be used. Biologic drugs like etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), anakinra (Kineret), canakinumab (Ilaris), tocilizumab (Actemra) and rituximab (Rituxan) are also approved JIA treatments. Most recently, an oral medication called tofacitinib (Xeljanz) has been used to treat JIA.

Living with JIA

Children with JIA may lead normal, active lives. They should attend school and engage in social, extracurricular, and family activities. Some children with JIA may need physical or occupational therapy to improve function, endurance, joint flexibility, and strength. If needed, therapists can fit children with splints or develop modifications to help with tasks at school. Federal Act 504 provides special accommodation at school for children with JIA.

Updated February 2023 by Nina T. Washington, MD, MPH, and reviewed by the Pediatric Rheumatology Subcommittee and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.