Polyarticular Juvenile Idiopathic Arthritis

Polyarticular Juvenile Idiopathic Arthritis

When children under 16 years old experience arthritis in five or more joints, it is known as polyarticular JIA. Remission is possible with treatment, however, some people continue to have symptoms as adults.

A collection of chronic inflammatory arthritis illnesses that can affect children is known as juvenile idiopathic arthritis (JIA). Within JIA, polyarticular disease is a subtype. To be polyarticular is to have multiple joints.

The most prevalent autoimmune condition in kids is JIA. The polyarticular subtype of JIA affects up to one-third of youngsters in Western nations. Polyarticular JIA is the most prevalent type of illness in various regions of the world.

JIA is a long-term illness. The symptoms could worsen, go away, or stay the same over time. For kids with polyarticular JIA, early intervention can help minimise symptoms, lessen joint deterioration over time, and enhance quality of life.

Rheumatoid factor and polyarticular JIA

Depending on whether the child's blood routinely tests positive for rheumatoid factor (RF), doctors divide polyarticular JIA into two categories. An antibody called RF is involved in persistent inflammation.

Although less frequent, RF-positive polyarticular JIA often has a higher severity.

What are the symptoms of polyarticular juvenile idiopathic arthritis?

You need to have chronic inflammatory arthritis for at least six weeks to be diagnosed with JIA. The onset of symptoms must occur before turning sixteen.

Both small and big joints develop inflammatory arthritis as a result of polyarticular JIA. It frequently affects the wrists and hands. Typically, affected joints are:

• swollen
• discolored
• stiff
• painful

Within the first six months of their illness, children with polyarticular JIA develop arthritis in five or more joints.

Signature symptoms of other different kinds of JIA, such as psoriasis or enthesitis, or indications of systemic disease, such as persistent fever and rash, must not be present in people with polyarticular JIA. These signs may indicate that you have a distinct type of JIA.

Up to 10% of kids with polyarticular JIA will also experience uveitis, a painful condition that causes redness and blurriness in the eyes and, if ignored, can cause blindness. Your kid's doctor will recommend routine eye exams and closely monitor your child for these symptoms if they are diagnosed with juvenile-onset arthritis (JIA).

Types of juvenile idiopathic arthritis

JIA comes in seven different varieties. Apart from the two varieties of polyarticular JIA, the following types exist:

• Systemic JIA: pain and symptoms affecting the entire body, including fever, rash, serositis, and enlarged lymph nodes, liver, or spleen
• Oligoarticular JIA: arthritis throughout the first six months in four or fewer joints
• Psoriatic JIA: arthritis as well as a personal or familial history of psoriasis, frequently accompanied by dactylitis or altered nails
• Enthesitis-related JIA: enthesitis and/or arthritis in boys under the age of six
• Undifferentiated JIA: arthritis that either fits into more than one category or does not fit into any of the preceding categories

What causes polyarticular juvenile idiopathic arthritis?

Being an autoimmune disease, JIA causes your immune system to unintentionally attack your body.

Your immune system targets your joints when you have JIA. Inflammatory arthritis results from this, causing pain, swelling, discolouration, and stiffness.

The reason your immune system malfunctions and starts inflaming your joints is still a mystery to medical professionals. They believe that a mix of environmental triggers, pathogens, and genetic risk factors are the reason.

Who gets polyarticular juvenile idiopathic arthritis?

With an estimated prevalence of roughly 1 in 1,000 children in the United States, JIA is the most prevalent autoimmune illness among children overall. Approximately one-third of these kids suffer from polyarticular JIA.

While JIA affects all populations, children of European ancestry are more likely to have it. The polyarticular subtype of JIA is the most common in Africa, India, and some regions of the Middle East, although it is less common in children of East Asian heritage when compared to other varieties.

15 percent or so of kids with polyarticular JIA had positive RF tests. Usually, they are girls between the ages of 10 and 13.

There are two peak age ranges of occurrence for RF-negative polyarticular JIA: 1-3 years and 9-14 years.

In females, both kinds are far more common. This is particularly valid for illnesses that are RF-positive.

How do doctors diagnose polyarticular juvenile idiopathic arthritis?

In addition to doing a physical examination and ordering blood tests to screen for inflammation and the presence of certain antibodies, your child's doctor will talk to you about their symptoms and the medical history of your family.

MRIs, ultrasounds, and X-rays are examples of imaging examinations that can be beneficial.

Your child may require the services of specialists like the following to assist diagnose and treat JIA:

• rheumatologist
• physical therapist
• ophthalmologist

What is the treatment for polyarticular juvenile idiopathic arthritis?

Treatments for polyarticular JIA may include the following recommendations from your doctor:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• tofacitinib (Xeljanz), a JAK inhibitor
• glucocorticoids administered intravenously or as brief oral doses
• conventional disease-modifying antirheumatic medications (DMARDs), such as methotrexate, that directly attack your immune system
• biologic DMARDs such as golimumab (Simponi), tocilizumab (Actemra), and etanercept (Enbrel)
• supportive treatments including icing, heating, and applying painkillers topically
• physical therapy with an emphasis on strengthening, flexibility, and range of motion

What is the prognosis for juvenile idiopathic arthritis with polyarticular symptoms?

The chronic illness known as JIA has no recognised treatment. But the illness may remit, and symptoms may come and go.

According to a 2017 review, 18 months following diagnosis, up to 7% of children with JIA have gone into remission. After ten or more years, that figure rose to almost forty percent.

Thirty years after diagnosis, 59% of participants in a 2016 survey of 176 JIA patients were in clinical remission and no longer on medication. It seemed that those with RF-positive polyarticular JIA had a lower chance of going into remission.

However, in light of current therapy advancements, these remission rates might be underestimated. Disease-modifying therapies can help control joint inflammation and long-term damage, improve joint remission prospects, and assist manage JIA symptoms when they are initiated on time.

However, a 2020 Canadian study with 247 participants found that some JIA patients still have persistent pain and disability from arthritis even with proper medication.

Particularly, RF-positive polyarticular JIA seems to have a higher propensity for persistence. Even with intensive treatment, a tiny fraction of JIA patients may require joint replacement surgery.

Takeaway

JIA is a collection of chronic inflammatory arthritic conditions identified in childhood, including polyarticular JIA. Within the first six months of the condition, children with polyarticular JIA experience inflammatory arthritis affecting five or more joints.

Their arthritis can worsen or go away over time. It might occasionally progress to impact more joints and cause different symptoms.

Both RF-positive and RF-negative polyarticular JIA are possible. Adolescent females are more likely to have RF-positive polyarticular JIA, which is also more difficult to induce into remission.

Even though JIA is a chronic condition, improved medications are improving the prognosis. Early DMARD use and prompt diagnosis can minimise joint deterioration and potential disability while also enhancing the quality of life. A lot of kids diagnosed with juvenile-onset arthritis will eventually go into remission and could even be able to stop taking their medicine.