Juvenile Idiopathic Arthritis

Maria Espinosa; Beth S. Gottlieb

doi:10.1542/pir.33-7-303

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Maria Espinosa, MD*
Beth S. Gottlieb, MD, MS*

^*The Steven and Alexandra Cohen Children’s Medical Center of New York, North Shore Long Island Jewish Health System, New Hyde Park, NY.

Author Disclosure

Drs Espinosa and Gottlieb have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

ANA:: antinuclear antibody
ARF:: acute rheumatic fever
AS:: ankylosing spondylitis
IBD:: inflammatory bowel disease
IL:: interleukin
IV:: intravenous
JIA:: juvenile idiopathic arthritis
MAS:: macrophage activation syndrome
NSAID:: nonsteroidal anti-inflammatory drug
RF:: rheumatoid factor
SLE:: systemic lupus erythematosus
TNF:: tumor necrosis factor

Educational Gap

Juvenile idiopathic arthritis affects around 294,000 children in the United States. In 2001, a new classification of the disorder and its subtypes was created. Current therapies, including the use of biologic medications, have improved the prognosis of this condition significantly.

Objectives

After completing this article, readers should be able to:

Understand the pathophysiology of juvenile idiopathic arthritis (JIA).
Recognize the clinical features of the different types of JIA.
Be aware of the complications of JIA.
Know the treatment of JIA.

Introduction

Juvenile idiopathic arthritis (JIA) is a broad term used to describe several different forms of chronic arthritis in children. All forms are characterized by joint pain and inflammation. The older term, juvenile rheumatoid arthritis, has been replaced by JIA to distinguish childhood arthritis from adult-onset rheumatoid arthritis and to emphasize the fact that arthritis in childhood is a distinct disease. JIA also includes more subtypes of arthritis than did juvenile rheumatoid arthritis.

JIA is the most common rheumatologic disease in children and is one of the more frequent chronic diseases of childhood. The etiology is not completely understood but is known to be multifactorial, with both genetic and environmental factors playing key roles. Without appropriate and early aggressive treatment, JIA may result in significant morbidity, such as leg-length discrepancy, joint contractures, permanent joint destruction, or blindness from chronic uveitis.

Definition

Arthritis is defined as joint effusion alone or the presence of two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased warmth in one or more joints. JIA is broadly defined as arthritis of one or more joints occurring for at least 6 …