July is Juvenile Arthritis Awareness Month

An estimated 300,000 U.S. children suffer from juvenile arthritis. Juvenile arthritis is a broad term covering multiple types of arthritis that can affect children’s joints, skin, eyes, and internal organs. Juvenile idiopathic arthritis (JIA) is the most common type.

July is Juvenile Arthritis Awareness Month. It serves to remind us of the children and families affected by juvenile arthritis, to support them, and to support ongoing research in the field.

Let’s look at juvenile arthritis, particularly JIA, current treatments, and ways to save on these costly medications by finding the lowest prescription price at a pharmacy near you.

Types of juvenile arthritis

Juvenile arthritis causes pain, stiffness, swelling, and loss of motion in the joints. It may come about as part of chronic diseases, such as lupus or dermatomyositis. More often, juvenile arthritis arises spontaneously without another associated disease.

This type of arthritis is called juvenile idiopathic arthritis (JIA), meaning its origin is unknown. It used to be called juvenile rheumatoid arthritis, but since it is not a downsized version of adult rheumatoid arthritis, the more descriptive name, juvenile idiopathic arthritis, replaced it.

JIA is the most common of all types of juvenile arthritis and will be our focus. There are six types of JIA:

• Oligoarthritis — affects four or fewer joints, usually large joints on one side of the body. It is the most common JIA, especially in kids six years old and younger.
• Polyarthritis — affects more than four joints, often on both sides of the body. It’s found in large and small joints. About 25% of children with JIA have this type.
• Systemic — this type of JIA affects joints, skin, and internal organs and often appears with a fever. About 10% of children with JIA have systemic variety.
• Psoriatic arthritis — arthritis affects large and small joints and is accompanied by a scaly, red rash behind the ears, at the elbows, on the eyelids, or on the scalp. This form may be inherited from a parent.
• Enthesitis-related — arthritis affects the joint where the muscles, tendons, and ligaments attach. In addition to large and small joints, it can affect the pelvic bones, spine, and internal organs. It’s diagnosed between ages eight and 15. This form may also be inherited from a parent.
• Undifferentiated — doesn’t play by the rules and can have symptoms that don’t fit with any type of symptoms that fit into several types of JIA.

Even though the list is cumbersome, you can use it as a reference while keeping a diary of your child’s symptoms. Write down or photograph the affected joint(s). It can be helpful to photograph both hands or knees, for example, as a comparison or to show both sides of the body are involved. Record the other symptoms your child is having. This will be part of the information your pediatrician will ask you about.

JIA is an autoimmune disease

Even though JIA has six types, the types share a common mechanism for joint damage. The body’s natural germ-fitting system, called the immune system, makes a mistake. In addition to targeting bacteria and viruses, the immune system attacks normal, healthy cells in joints. In some cases, eyes and internal organs are attacked, too.

So, while the mechanism behind juvenile idiopathic arthritis is known, why it occurs remains a mystery. It is idiopathic or spontaneously arising from a malfunctioning immune system for an unknown reason. Juvenile idiopathic arthritis is an autoimmune disease like Type I diabetes, inflammatory bowel disease, and multiple sclerosis.

JIA does not seem to be linked to foods, vitamin deficiencies, allergies, or exposure to toxins. The autoimmune response may be triggered when a bacteria or virus turns on a gene’s attack mode. Researchers continue to look for answers.

Who gets JIA

Overall, JIA affects more girls than boys, with two exceptions:

• Systemic JIA affects boys and girls equally
• More boys get enthesitis-related JIA than girls

JIA can occur at any age up to 16 years old but is very rare in infants less than six months of age. JIA doesn’t discriminate based on race or ethnicity. Kids who have a parent with psoriasis have a slightly higher risk of getting psoriatic arthritis. And children who have a parent with chronic arthritis are more likely to develop JIA.

Overall, the chance of more than one child in the family developing JIA is very rare.

Signs and symptoms

Not every child will have every sign or symptom of JIA. And signs and symptoms of JIA may change over time. Here are the most common findings:

• Painful joints
• Swollen joints
• Red joints
• Stiff joints
• Warm-to-the-touch joints
• Fever
• Fatigue
• Loss of appetite
• Blurry vision, dry, gritty eyes, red eyes, or eye pain
• Skin rashes, red, scaly skin patches, or lumps under the skin

Joint pain and stiffness can worsen in the morning, after a nap, or inactivity. Younger children may not complain of joint pain but instead will limp, become clumsy, or have motor skill setbacks or a loss of dexterity.

If you notice any signs or symptoms of JIA lasting for more than a week, make an appointment with your child’s healthcare provider. If your child has a fever, take a look at these guidelines about when to seek care.

For joint problems to be diagnosed as JIA, arthritis needs to be ongoing, lasting more than six weeks. Making the diagnosis will take some time. So, getting an appointment sooner can mean treatment is started earlier, and joint damage is lessened.

Diagnosing JIA

No single blood test or X-ray makes the diagnosis of JIA. Instead, your healthcare provider will gather information about your child’s signs, symptoms, and other medical conditions. This is when you can help your child’s doctor with a diary of symptoms, photos of the joints, and a timeline.

Your child’s doctor will perform a physical exam and order lab tests to look for other potential causes of arthritis. JIA is a diagnosis of exclusion, meaning other diseases and illnesses need to be looked for and dismissed as the culprits.

Other diseases and illnesses that can cause arthritis include:

• Infections
• Lupus
• Lyme disease
• Bone diseases
• Some childhood cancers

If the medical history, physical exam, blood tests, and imaging studies fail to show other causes for arthritis, JIA is left as the most likely cause of arthritis.

Blood tests

Your healthcare provider may order several blood tests to look for:

• Evidence of inflammation in the body
• autoantibodies — immune system proteins targeting healthy cells
• rheumatoid factor — a marker of rheumatoid arthritis (very rare in children)
• the HLA-B27 gene — linked to enthesitis-related JIA.

Imaging studies

Your child’s healthcare provider may order x-rays, ultrasounds, or MRIs of the affected joints. These imaging studies look for any damage to the joint. MRIs and ultrasounds show damage before x-rays do.

Images of the bones, joints, and space around the joints will help guide treatment and serve as a tool to compare the health of the joint before and after treatment.

Treatment goals

Treatment aims to reduce symptoms, maintain joint function, and prevent joint damage. A comprehensive treatment approach includes medications, physical and occupational therapy, and adjunctive treatments. Usually, a team of doctors (pediatrician, pediatric rheumatologist, eye doctor) and therapists work together.

Healthcare providers focus on aggressive treatment of JIA with medications early in the disease’s course. In time, medications may be reduced or stopped if your child goes into remission.

Disease-controlling medications

Disease-controlling drugs work at the root of the problem — the immune system. Methotrexate (Rheumatrex) is a disease-modifying anti-rheumatoid drug (DMARD). It’s the most commonly prescribed medication for JIA and a first-line drug. Your child’s rheumatologist (arthritis doctor) may prescribe methotrexate combined with newer medications called biologics.

Biologics work on particular steps of the inflammatory process. The Food and Drug Administration (FDA) has approved five biologics for children:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Canakinumab (Ilaris)
• Etanercept (Enbrel)
• Tocilizumab (Xeljanz)

Symptom-relieving medications

• Anti-inflammatory drugs — ibuprofen (Motrin or Aleve) and naproxen (Naprosyn)
• Corticosteroids — most commonly injected into a single joint to quickly calm local inflammation

Physical therapy and adjunctive treatments

In addition to medications, a comprehensive treatment approach includes:

• Physical and occupational therapy to increase muscle strength and maintain full range of motion in the joints
• Rest during flares or acute episodes of arthritis
• Exercise during remission, especially swimming
• Joint care with heat (including shower or bath) applied during stiffness and cold packs applied during swelling
• Splints and braces
• Guided visualization or meditation for pain relief

Ways to save on JIA medications

Biologics are relatively new, highly effective medications that come with a high price tag. Fortunately, it’s easier than you might expect to save money on them. A quick search of biologic prices on ScriptSave^® WellRx shows thousands of dollars* in savings between the lowest prescription prices and highest, particularly with Orencia, Ilaris, and Xeljanz.

Methotrexate and over-the-counter symptom-relieving medications are a mere fraction of the cost of biologics, but it still pays to compare prescription prices at WellRx.

To learn more about how prescription discount cards work, receive a free Rx savings card, and print, text, or email yourself coupons for medications, visit WellRx.

Prognosis

Seeking medical care for your child’s joint pain and receiving proper treatment with medication, physical therapy, and occupational therapy will help prevent joint damage and control the arthritis symptoms. Some children will enter remission and have few or no symptoms. Others will need ongoing treatment but can expect to have normal or near-normal function.

Early diagnosis and treatment are essential.

Finding help, lending support

The Arthritis Foundation has resources and information about support groups if your child has JIA. If you’re interested in donating to this organization, proceeds go to scientific research, legislative work, and programs supporting those affected by arthritis.

Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

Resources:

https://www.arthritis.org/diseases/juvenile-idiopathic-arthritis

https://www.arthritis.org/diseases/lupus

https://www.arthritis.org/diseases/juvenile-dermatomyositis

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis

https://www.niams.nih.gov/health-topics/juvenile-arthritis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753598/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216020/

https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritis

https://www.psoriasis.org/about-psoriatic-arthritis/

https://rarediseases.info.nih.gov/diseases/10969/enthesitis-related-juvenile-idiopathic-arthritis

https://autoimmune.org/disease-information/

https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759#:~:text=When%20to%20see%20a%20doctor

https://www.niams.nih.gov/health-topics/juvenile-arthritis/diagnosis-treatment-and-steps-to-take