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Juvenile Idiopathic Arthritis (JIA) is a heterogenous group of complex autoimmune disorders, which affects around 1 in 1,600 children and young people under the age of 16*.
It is characterised by joint inflammation lasting at least six weeks, where injury and infection are either ruled out or cannot be confirmed.
If a child under the age of 16 presents to you with any of the following, it could be JIA:
Joint inflammation – pain, swelling, reduced mobility, morning stiffness. This might be obvious, but in some cases is not.
If the child cannot now do something that they could previously, Think – could this be JIA? For example, if they could write but now cannot. Or if they could walk but now cannot. Or if they could sit on the floor but now cannot. These are all indicative of reduced joint mobility and/or pain due to joint inflammation.
You can assess for joint inflammation using pGALS and pREMS, but this is not necessary before referring to specialist services. Further information can be found on pmmonline (an educational resource endorsed by NICE, RCPCH and PReS).
Blood tests can be completely normal in JIA. Inflammatory markers may be normal, yet the joints can still be inflamed. Some children with JIA are RF positive (Rheumatoid Factor), but many are not. Some may be ANA-positive, but many are not. Whilst blood tests can be helpful in ruling out other conditions, blood tests alone cannot be used to diagnose if a child has JIA. Normal blood tests do not mean the child does not have JIA.
X-rays, ultrasound and MRI imaging can appear normal in a child with JIA.
For more information about the subtype known as Systemic JIA (also known as Still's disease), please visit our site at www.stillsdisease.uk
Research* has found that there is a much higher incidence of arthritis amongst children with Down Syndrome (Trisomy 21), with as many as 1 in 50 children with Down Syndrome having a form of arthritis called 'Down Syndrome Associated Arthritis'. This leaflet from Childrens Health Ireland gives further information, including some of the signs and symptoms to look out for. As with other forms of childhood arthritis, the key message is if in doubt refer to paediatric rheumatology.
* dx.doi.org/10.1136/rmdopen-2018-000890
GPs, A&E teams and orthopaedic teams are not expected to diagnose JIA. The key concern is that a child who may have JIA must be referred to a paediatric rheumatologist immediately, even if imaging and blood tests appear normal. Failure to do so promptly could lead to permanent joint damage and poor long-term health outcomes.
You may wish to direct your patients to our comprehensive guide to living with JIA, called My JIA booklet, which includes tips and suggestions on how schools can support children with the condition. It is available to download here.
Introduction to paediatric rheumatology for health professionals
Introduction to paediatric rheumatology for health professionals
This video, produced by the Liverpool Paediatric Society, explains what paediatric rheumatologists do and how they investigate and manage the conditions they treat, including JIA. This is a must-watch for any GPs and other front-line health professionals to give them the confidence to know when to refer. Prompt referral to paediatric rheumatology is vital - if in doubt, refer.
Dr Smith from Alder Hey Children's Hospital covers:
•To understand why it is important to recognise rheumatic diseases in children and young people?
•To recognise patterns of clinical symptoms / signs associated with different paediatric rheumatic diseases, to aid a diagnosis
•To be aware of WORD day, and the importance of raising awareness of paediatric rheumatic diseases
* "Around 1 in 1,600 children are diagnosed with JIA" is based on our latest research (https://doi.org/10.1093/rheumatology/kead700). The previous estimate of around 1 in 1,000 may continue to appear on our website and in some of our printed materials whilst we update to the new figures.
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