The Diagnosis and Management of Juvenile Idiopathic Arthritis
The Diagnosis and Management of Juvenile Idiopathic Arthritis
Juvenile arthritis is the most common rheumatic childhood disease in the United States. According to the Arthritis Foundation (2009), juvenile arthritis is any form of arthritis or arthritis condition that develops in persons younger than 18 years. The Centers for Disease Control and Prevention (2009) list three clinical classification schemes for childhood arthritis: juvenile rheumatoid arthritis, juvenile chronic arthritis, and juvenile idiopathic arthritis (JIA). The Arthritis Foundation (2009) further categorizes JIA into three major types: polyarticular juvenile rheumatoid arthritis, pauciarticular juvenile rheumatoid arthritis, and systemic onset juvenile rheumatoid arthritis. The newest classification system was formed by the International League Against Rheumatism, which defined seven subsets of juvenile arthritis.
This practice guideline will focus on the diagnosis and management of three subsets, oligoarticular, polyarticular, and systemic arthritis, which encompass what most providers think of as JIA (Cassidy, Petty, Laxer, & Lindsley, 2005; Goldmuntz & White, 2006).
Physical disabilities include joint distortions, musculoskeletal deformities, and impaired physical function(s) (Cassidy et al., 2005). Morning joint stiffness or stiffness after naps improves as the day goes on.
JIA has been linked to psychological disabilities including depression, isolation, decreased self-esteem, and altered body image (Fagg, Curtis, Stansfeld, & Congdon, 2006; Kyngas & Rissanen, 2001; Suris, Parera, & Puig, 1996). The presence of persistent pain and the lack of recognition of arthritis resulting in delay of diagnosis and treatment often lead to patient and family anxiety and frustration (Len et al., 2006; Pols et al., 2009).
Background
Definition
Juvenile arthritis is the most common rheumatic childhood disease in the United States. According to the Arthritis Foundation (2009), juvenile arthritis is any form of arthritis or arthritis condition that develops in persons younger than 18 years. The Centers for Disease Control and Prevention (2009) list three clinical classification schemes for childhood arthritis: juvenile rheumatoid arthritis, juvenile chronic arthritis, and juvenile idiopathic arthritis (JIA). The Arthritis Foundation (2009) further categorizes JIA into three major types: polyarticular juvenile rheumatoid arthritis, pauciarticular juvenile rheumatoid arthritis, and systemic onset juvenile rheumatoid arthritis. The newest classification system was formed by the International League Against Rheumatism, which defined seven subsets of juvenile arthritis.
This practice guideline will focus on the diagnosis and management of three subsets, oligoarticular, polyarticular, and systemic arthritis, which encompass what most providers think of as JIA (Cassidy, Petty, Laxer, & Lindsley, 2005; Goldmuntz & White, 2006).
Incidence
JIA is the most common cause of chronic arthritis in children, with racial predilection depending on the subset of arthritis considered.
Approximately one in 1000 children or more than 300,000 children in the United States have JIA.
Depending on the arthritis subset, JIA may affect girls more frequently than boys and may predicate which joints are involved (Feldman et al., 2007).
Symptomatology
Physical disabilities include joint distortions, musculoskeletal deformities, and impaired physical function(s) (Cassidy et al., 2005). Morning joint stiffness or stiffness after naps improves as the day goes on.
Painful and swollen joint(s) sometimes are noticed in association with a recent trauma. In most instances the joint swelling previously was present, but scrutiny of the injured site results in identification of the swelling and pain. The injury usually does not cause JIA.
Affected persons may have unilateral or bilateral joint involvement.
Affected persons have persistent pain that is refractory to over-the-counter remedies.
Symptoms must persist for at least 6 weeks within a 6-month period.
JIA has been linked to psychological disabilities including depression, isolation, decreased self-esteem, and altered body image (Fagg, Curtis, Stansfeld, & Congdon, 2006; Kyngas & Rissanen, 2001; Suris, Parera, & Puig, 1996). The presence of persistent pain and the lack of recognition of arthritis resulting in delay of diagnosis and treatment often lead to patient and family anxiety and frustration (Len et al., 2006; Pols et al., 2009).
Etiology/Pathophysiology
The International League Against Rheumatism classifications include:
Polyarticular, with a prevalence of 40%
Pauciarticular (oligoarticular), with a prevalence of 50%
Systemic, with a prevalence of 10% (Cassidy et al., 2005)
JIA is considered an autoimmune disease