How to Spot Juvenile Arthritis in Your Child

What comes to mind when you think of arthritis? More often than not, you may picture an elderly person hobbling around, dealing with the daily struggles of joint inflammation with each painful step.

But arthritis affects children, too. At any point before your child matures into an adult, his or her body may experience a chronic inflammatory response that causes joint pain, skin rashes or more complex internal organ issues.

These symptoms are treatable, as we’ll outline below, but you’ll first need to recognize if your child has juvenile arthritis. The quicker you obtain a diagnosis, the more proactive doctors can be with treatments that can allow your child to live a long, healthy life. With July serving as Juvenile Arthritis Awareness Month, we put together a comprehensive guide outlining how to spot these diseases, the types of arthritis in children, and ways to keep symptoms under control.

What is juvenile arthritis?

Arthritis, whether it occurs in children or adults, is an umbrella term to describe more than 100 types of inflammatory and rheumatic diseases. Juvenile arthritis, or childhood arthritis, is an autoimmune disease in which the immune system attacks healthy cells and tissues and releases inflammatory chemicals. As a result, swelling occurs around the joints, skin or other organs. 

Juvenile arthritis affects 294,000 American children under the age of 18. It’s a chronic condition, but can go into remission for months or years. Many children recover, but some can carry on into adulthood where it becomes an issue of managing the symptoms. 

Why certain children develop arthritis is unknown, however it could trace back to family history and genetics. It’s possible the disease is triggered by a virus or other bacterial infection. While it’s common to wonder if there’s a way to prevent juvenile arthritis, such as a specific diet, there isn’t research that points in this direction. However, avoiding certain foods that may lead to inflammatory responses can help joints in the long run.

Juvenile arthritis symptoms

There are more than 300 joints in the human body. In children with juvenile arthritis, these joints — defined as a point or place where two or more structures meet — become inflamed, leading to pain, swelling, stiffness, tenderness and a loss of motion.

Childhood arthritis commonly affects the hands, feet, and knees, which can make it difficult to perform activities and can lead to clumsiness. Your child may notice symptoms worsen in the mornings, after a nap, or if your child stays in one position for a long period of time and stiffness can set in.

A common misnomer is juvenile arthritis only impacts joints. Inflammation from arthritis can also cause fevers, skin rashes and lymph node swelling. Your child may also develop red or pink skin rashes, butterfly-shaped rashes on the face or rashes that create hard skin.

Eye pain, dryness, redness, or vision problems can signal arthritis is causing chronic eye inflammation in your child. The inflammation may also reach internal organs and cause swelling in the lungs, heart or digestive tract. Monitor your child for unexplained problems breathing, appetite changes, weight gain or constant fatigue.

Collectively, these symptoms are important to monitor because they can impact your child’s ability to take part in common physical activities. As a result, your child may struggle in social situations or with everyday tasks such as schoolwork or homework. Pain in the hands, wrist, or fingers can make completing tasks difficult. 

An inability to live a normal childhood may also lead to mental health issues, such as depression or social anxiety. A strong family support system can help your child navigate these difficult times.

Types of juvenile arthritis

Knowing the various types of juvenile arthritis can help give you a better idea of what to look for if your child experiences joint inflammation, skin rashes or internal organ issues.

Juvenile idiopathic arthritis 

Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis, is the most common type of arthritis found in children. The word idiopathic means these arthritic diseases come from unknown causes. By definition, JIA starts before the age of 16 and causes symptoms that last at least six weeks. The six types of JIA are detailed below.

• Oligoarticular juvenile idiopathic arthritis (Oligoarthritis): The most common type of JIA, oligoarthritis affects four or fewer joints, mainly large ones such as knees and ankles. This disease is more common in girls.
• Polyarticular juvenile idiopathic arthritis (Polyarthritis): Affects five or more joints, both small and large. This disease is more common in girls.
• Systemic juvenile idiopathic arthritis: Although it’s the least common type, it still affects the entire body and can cause fever and skin rashes. Severe cases can cause organ inflammation. This disease is equally common among boys and girls.
• Psoriatic juvenile idiopathic arthritis: A combination of joint inflammation and psoriasis, this skin disorder causes a scaly, red rash on various parts of the body.
• Enthesitis-related juvenile idiopathic arthritis: Causes inflammation where muscles, ligaments or tendons connect to bones. The ankles, feet, hips and spine are commonly impacted. This disease is more common in boys ages 8 and up. It can cause ankylosing spondylitis, which leads to inflammation in the joints between the hip and spine. 
• Undifferentiated arthritis: Defined as symptoms from two or more of the above types of JIA. In some cases, symptoms don’t fit any category.

Juvenile dermatomyositis

Juvenile dermatomyositis attacks healthy blood vessels, leading to skin and muscular inflammation. You may notice a rash around your child’s eyes, knuckles, knees or elbows followed by muscle weakness. This disease is more common in girls than boys and typically occurs between the ages of 5 and 10.

Juvenile lupus

The immune system attacks healthy tissues, causing heightened levels of inflammation in various parts of your child’s body — anything from the skin to nervous system. Systemic lupus erythematosus (SLE) is the most common type and can affect several body parts and internal organs at the same time. It’s more common in girls than boys and typically occurs in teenagers.

Juvenile scleroderma

Sclera is a word for hard, so the name of the condition translates to “hard skin.” The body attacks healthy tissue and cells to create inflammation that leads to excess collagen production.  This protein buildup results in tight, rough skin that looks scarred. Your child could have either systemic or localized scleroderma. As the name suggests, localized scleroderma is limited to the skin, joints, muscles and bones. Systemic scleroderma, which is more common in adults, can affect internal organs.

Vasculitis

Inflammation of the blood vessels can lead to heart complications. Kawasaki disease is the most common type of vasculitis. Symptoms, which range from swollen lips, hands, feet and lymph nodes to rashes, typically occur before the age of 5. This disease is more common in boys than girls.

Please visit this INTEGRIS podcast to learn more about the effects of COVID-19 on Kawasaki disease.

How to treat juvenile arthritis

If you’re a parent, you may wonder: How do you test for juvenile arthritis or is juvenile arthritis life threatening? First, talk to a rheumatologist or pediatrician if you notice your child suffering from constant pain, swelling or any type of unexplained skin rashes. Some rheumatologists specialize in treating children.

Your doctor will first ask about family history to determine if there are other instances of arthritis. Often, a physical examination is a prime indicator of childhood arthritis. You may need diagnostic imaging, such as an X-ray, to analyze the joints or blood work to determine any inflammatory markers. Treating these conditions early can help slow down the progression into adulthood and minimize long-term effects.

Exercise and therapy treatments

Once your doctor confirms a diagnosis, they can set your child up with a treatment plan to reduce any pain, swelling or skin rashes. Exercising is the best way to keep juvenile arthritis under control. Walking and biking are low-impact activities your child can enjoy. Swimming is one of the preferred exercise methods since water’s buoyancy puts less pressure on joints.

Physical activity may seem counterproductive if your child’s joints are swollen or painful, but staying mobile will help keep joints loose and flexible to maintain a range of motion. Have your child take breaks or rest days if certain body parts become inflamed.

A physical therapist can work with your child on ways to strengthen joints and muscles and maintain flexibility. In more moderate cases, your child may find relief from massage therapy or acupuncture. 

Juvenile arthritis medications

Your doctor may recommend juvenile arthritis medications that limit the body’s immune system from attacking healthy joints, thus slowing down or delaying the progression. Disease-modifying anti-rheumatic drugs (DMARDs) treat the problem itself, while over-the-counter drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), help combat the symptoms. 

Methotrexate is among the most common DMARD due to its effectiveness and long-term use. Even if symptoms improve, your child should still take the drug, which comes in pill or injectable form, weekly to prevent future outbreaks. Hydroxychloroquine, taken once daily in pill form, and sulfasalazine, taken twice daily in pill or liquid form, can also treat arthritis in children. 

Contact the INTEGRIS rheumatology department if you think your child may have juvenile arthritis.