Types of Juvenile Arthritis and Treatment Steps for Families

Medically Reviewed By Margaret R. Li, MD, FACR
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About 300,000 children in the United States have juvenile arthritis, or JA. It is a group of inflammatory diseases that can develop in children under age 16. There are effective treatments for JA, and many children outgrow it or respond well to treatment. Juvenile arthritis (JA) is a disease of the immune system. The immune system overreacts and mistakenly attacks the body’s own tissues. It can be autoimmune, meaning a child is born with it, or autoinflammatory, which develops after birth.

Here is an overview of JA, including types and symptoms. This article will also include support tips for families, including school accommodations for children with JA.

Sex and gender terms

Sex and gender exist on spectrums. This article will use the terms “boys” and “girls” to reflect sex assigned at birth in order to accurately reflect language used in source materials.

What are the different types of juvenile arthritis?

There are different types of juvenile arthritis, which vary in severity and symptoms. They include the following. 

Juvenile idiopathic arthritis (JIA)

This is the most common form of JA. Idiopathic means the cause is unknown.

There are six subtypes of JIA:

  • Oligoarthritis is the most common type of JIA, accounting for up to 70% of all JIA cases in children from birth to 6 years. It affects up to four joints and can progress to other joints.
  • Polyarthritis affects five or more joints within the first 6 months of the condition. About 25% of children with JIA have the polyarthritic type.
  • Systemic arthritis is the most severe type of JIA. It affects multiple areas of the body, including internal organs.
  • Enthesitis-related arthritis affects the entheses, which are the areas where tendons, ligaments, and muscles connect to bones. This type is more common in boys.
  • Juvenile psoriatic arthritis is a type of arthritis that can occur in children with psoriasis. Psoriasis is an autoimmune condition that causes scaly patches to appear on the skin.
  • Undifferentiated arthritis describes when a child has several of the above signs and symptoms without matching specifically to one subtype.

Other types

Other forms of juvenile arthritis, most of which are rare, include:

  • Juvenile lupus: This causes inflammation and potential damage to skin, joints, kidneys, nervous system, heart, and lungs.
  • Juvenile vasculitis: This causes inflammation of the walls of blood vessels.
  • Juvenile myositis: This causes muscle weakness and skin rash.
  • Juvenile scleroderma: This causes hardening and tightening of the skin, as well as fibrous changes in the internal organs.
  • Fibromyalgia: This causes musculoskeletal pain, fatigue, and sleep disturbance.

What are the symptoms of juvenile arthritis?

Young child playing with colored blocks
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The symptoms of JA can be subtle or severe. Pain tends to be worse in the morning or after sitting or napping. Younger children may not mention that their joints hurt, but parents may notice them limping.

Symptoms can come and go. They last for weeks or months in some children. Others may have a flare or two and never have one again.

Common symptoms of juvenile arthritis

The most common symptoms of JA include:

  • swollen, warm, and painful joints that can make it hard to move
  • fatigue
  • lack of appetite

Depending on the type of JA, children may also have:

The most severe type of JIA, systemic juvenile idiopathic arthritis, is rare. However, it can cause problems with the heart and lungs. If your child has systemic JIA and you notice shortness of breath or chest discomfort, call a doctor right away.  

What causes juvenile arthritis?

The exact cause of JA is not known. The American Academy of Orthopaedic Surgeons explains that changes in certain genes may play a role.

Some researchers believe the development of JA may be a two step process. External factors, such as a viral or bacterial infection, may trigger the disease in a child with the genetic makeup for JA.

What are the risk factors for juvenile arthritis?

Most information available about JA risk factors focuses on the idiopathic type. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) outlines JIA prevalence as follows:

Type of JIAPrevalence
enthesitis-related JIAmore common in boys
systemic JIAaffects boys and girls equally
other forms of JIAmore common in girls

The NIAMS notes that JIA affects children of all races and ethnic backgrounds equally.

How do doctors diagnose juvenile arthritis?

Because there are many possible causes of joint pain, JA can be difficult to diagnose.

In addition to a physical examination, doctors may perform tests to look for signs of JA. They may also use test results to rule out other conditions that may be causing symptoms.

If you notice your child limping or looking stiff in the morning, contact a healthcare professional. Even if your child does not mention any symptoms or complain about pain, talk to your pediatrician. They can refer you to a pediatric rheumatologist for further evaluation of possible JA.

Tests to diagnose juvenile arthritis

Tests that can help indicate possible JA include:

  • Erythrocyte sedimentation rate and C-reactive protein: These blood tests that can detect inflammation in the body.
  • Antinuclear antibody (ANA): This is a nonspecific test looking for a specific type of antibody. A child with oligoarticular JIA and a positive ANA test is at increased risk of developing eye inflammation. However, this test can produce false positives if the child is healthy.
  • Rheumatoid factor: This blood test looks for a specific antibody that is present in people with rheumatoid arthritis (RA). A positive result in children may indicate polyarticular JIA.
  • HLA-B27 typing: This blood test identifies the presence of a gene linked to enthesitis-related JIA.
  • Complete blood count: This blood test measures the counts of specific types of blood cells. High counts of white blood cells and low counts of red blood cells can be signs of some types of arthritis.
  • Imaging tests: Tests such as X-rays, CT scans, and MRI scans can identify areas of joint inflammation and the severity of joint damage.

Different forms of JA need different treatments. Your doctor and medical team will discuss available treatment options in the context of your child’s individual diagnosis.

What are treatments for juvenile arthritis?

There is no cure for JA. The goals of treatment are to manage and relieve symptoms and to prevent further joint damage. With treatment, it is possible to achieve remission, meaning the disease is nearly or completely undetectable.

Prompt treatment of JA can help reduce the chance of joint problems that can affect growth, mobility, and function throughout life. In severe cases, some children may require surgery to repair damaged joints.

Medications and other forms of treatment include the following:

  • Disease-modifying antirheumatic drugs (DMARDs) and biologics are systemic or targeted drugs that reduce the immune system response, protecting joints from damage. Methotrexate is the DMARD doctors most commonly prescribe to treat JA.
  • Nonsteroidal anti-inflammatory drugs and analgesics such as ibuprofen (Advil) or acetaminophen (Tylenol) can provide temporary pain relief. They are available over the counter or in prescription strength.
  • Corticosteroids are medications that have anti-inflammatory and immunosuppressive effects. Doctors often use them to treat acute flare-ups or as bridging therapy while waiting for maintenance medications to take effect, which can take weeks or months. Corticosteroids typically are an oral medication. However, during severe flare-ups, healthcare professionals can administer it intravenously or by injection into the muscle or joints. 
  • Physical and occupational therapy can help can improve function, balance, and coordination.
  • Assistive devices such as hand grips, braces, or splints can help children as they work to strengthen muscles and improve flexibility.
  • Joint replacement surgery is rare but may be necessary in severe cases of JA. A case is severe when joint damage is extensive or other treatments are not effective in managing symptoms.

An estimated half of children with JA outgrow it. However, the other half require aggressive treatment to prevent continued arthritis as they get older.

Home care for juvenile arthritis

Your medical team can talk you through steps to take at home to support a child with JA.

The NIAMS recommends healthy living habits that can improve quality of life with JA, including:

  • applying cold packs to affected joints to reduce pain and swelling
  • using heating pads or warm showers to loosen stiff joints
  • participating in low impact physical activity — such as walking, swimming, or biking — during times when symptoms are less active
  • scheduling periods of rest, particularly when symptoms are active
  • reducing stress through meditation, mindfulness, and social outings with friends
  • participating in a local support group for children with JA

School support for juvenile arthritis

Depending on the severity of your child’s symptoms, JA can affect your child’s ability to attend school. This can include difficulty completing work in class or even needing to be absent for long periods of time.

Your doctor and medical team can help provide guidance on what types of support your child may need at school. You can also develop a 504 plan. This is a federal protection that requires schools to provide reasonable accommodations for children with disabilities.

You can work with your child’s teacher and school administrators so your child has the tools they need to progress in school.

Summary

Juvenile arthritis (JA) is a term that comprises several inflammatory diseases that can develop in children under 16 years old. The most common type of JA is juvenile idiopathic arthritis (JIA), which is JA that develops with no known cause.

Treatments for JA focus on reducing symptoms and bringing about remission, meaning symptoms become nearly or completely undetectable. Medication, physical therapy, exercise, and social support can significantly reduce the impact of JA. Many children with JA lead a thriving, healthy life.

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Medical Reviewer: Margaret R. Li, MD, FACR
Last Review Date: 2022 May 31
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