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July is Juvenile Arthritis Awareness Month

There could be a very good reason that your child is having increased pain or a rash or fever. Juvenile Idiopathic Arthritis or JIA is a group of inflammatory disorders, where the immune system attacks itself, causing increased pain and discomfort. According to the National Institute of Health or NIH, “The incidence of juvenile idiopathic arthritis in North America and Europe is estimated to be 4-16 in 10,000 children. One in 1,000, or approximately 294,000, children in the United States are affected”. which is an extremely high incidence and worth noting. Females are affected more often than males and usually the symptoms present themselves before the age of 16 years old. Diagnosis of Juvenile Idiopathic Arthritis is from a few different things such as signs and symptoms of the disease, laboratory testing and family history. The cause of this disorder is unclear. Genes and environmental factors are thought to play a role in these disorders. Infection or other inflammatory conditions and immune health may also contribute to the development of this disorder.

There are seven types of juvenile idiopathic arthritis:

1. Systemic juvenile idiopathic arthritis causes inflammation in one or more joints. A high daily fever that lasts at least 2 weeks either precedes or accompanies the arthritis. Individuals with systemic arthritis may also have a skin rash or enlargement of the lymph nodes (lymphadenopathy), liver (hepatomegaly), or spleen (splenomegaly).

2. Oligoarticular juvenile idiopathic arthritis (also known as oligoarthritis) is marked by the occurrence of arthritis in four or fewer joints in the first 6 months of the disease. It is divided into two subtypes depending on the course of disease. If the arthritis is confined to four or fewer joints after 6 months, then the condition is classified as persistent oligoarthritis. If more than four joints are affected after 6 months, this condition is classified as extended oligoarthritis. Individuals with oligoarthritis are at increased risk of developing inflammation of the eye (uveitis).

3. Rheumatoid factor positive polyarticular juvenile idiopathic arthritis (also known as polyarthritis, rheumatoid factor positive) causes inflammation in five or more joints within the first 6 months of the disease. Individuals with this condition also have a positive blood test for proteins called rheumatoid factors. This type of arthritis closely resembles rheumatoid arthritis as seen in adults.

4. Rheumatoid factor negative polyarticular juvenile idiopathic arthritis (also known as polyarthritis, rheumatoid factor negative) is also characterized by arthritis in five or more joints within the first 6 months of the disease. Individuals with this type, however, test negative for rheumatoid factor in the blood.

5. Psoriatic juvenile idiopathic arthritis involves arthritis that usually occurs in combination with a skin disorder called psoriasis. Psoriasis is a condition characterized by patches of red, irritated skin that are often covered by flaky white scales. Some affected individuals develop psoriasis before arthritis while others first develop arthritis. Other features of psoriatic arthritis include abnormalities of the fingers and nails or eye problems.

6. Enthesitis-related juvenile idiopathic arthritis is characterized by tenderness where the bone meets a tendon, ligament, or other connective tissue. The most commonly affected places are the hips, knees, and feet. This tenderness, known as enthesitis, accompanies the joint inflammation of arthritis. Enthesitis-related arthritis may also involve inflammation in parts of the body other than the joints.

7. undifferentiated arthritis. This classification is given to affected individuals who do not fit into any of the above types or who fulfill the criteria for more than one type of juvenile idiopathic arthritis.

Management of the disease is usually ongoing with a combination of symptom control and lifestyle modification. Patients are usually managed by a specialist pediatric rheumatology multidisciplinary team. Physical and occupational therapy are usually on board. Sometimes oral, intra-articular or intravenous steroids are used as well as other medications specific for the disease. All those that suffer from this disease must be tested and continue with regular ophthalmologic (eye) examinations to detect and prevent visual decline. Early detection and management is key.

For help deciding if your child is suffering from this, please contact your child's pediatrician. We are here to help support your needs at . Feel free to schedule a visit. Also, on July 25th, 2020 at noon join us for a special event, Managing Adolescent fears in a Pandemic: Live Q & A., to help your child get ready for the 2020/21 school year.

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