Pediatrics · Topic 4 of 42
Juvenile Idiopathic Arthritis (JIA)
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Juvenile Idiopathic Arthritis (JIA)
Autoimmune arthritis that starts before age 16 and lasts 6 weeks or more. The hidden danger is silent uveitis that can cost vision.
Why it happens
Autoimmune joint inflammation that starts before age 16
RF-positive polyarticular JIA, usually in adolescent girls, resembles adult rheumatoid arthritis.
What you'll see
Morning stiffness and a limp · systemic: daily spiking fever + salmon rash
Systemic JIA can also cause an enlarged liver and spleen, swollen lymph nodes and serositis (pericarditis, pleuritis).
Labs & monitoring
Slit-lamp eye exams on schedule, even without symptoms
Slit-lamp screening in new oligoarticular or polyarticular JIA: every 3 months if ANA-positive, every 6 months if ANA-negative; yearly or twice yearly in systemic JIA.
Red flags
Macrophage activation syndrome, a life-threatening cytokine storm, complicates systemic JIA in about 7–10% of children.
Treatment
Give with food; watch for stomach upset or bleeding
Do not prevent joint damageFolic acid, CBC and liver tests; no alcohol
Causes birth defects — reliable contraceptionTB test first; report any sign of infection
No live vaccinesLong use slows growth; joint injections for a few joints
Biologic safety and outlook
Nursing priorities
Oligoarticular or polyarticular?
Count the joints: 4 or fewer vs 5 or more
| Oligoarticular | Polyarticular | |
|---|---|---|
| Joints | 4 or fewer | 5 or more |
| Who | Often young girls | RF-positive type: usually adolescent girls |
Teach the family
Give all age-appropriate vaccines before immunosuppressive treatment starts.
JIA uveitis is silent — keep slit-lamp eye exams even when the eyes look and feel fine. And methotrexate is once a week, never daily.
Sources · Juvenile Idiopathic Arthritis (MSD Manual Professional) · Juvenile Arthritis (American College of Rheumatology) · Juvenile Idiopathic Arthritis (Arthritis Foundation) · Methotrexate (MedlinePlus) · Etanercept Injection (MedlinePlus) · ENBREL (etanercept) label (DailyMed) · ILAR classification of JIA (J Rheumatol) · Follow your facility's protocol for giving immunosuppressive medications.
Juvenile Idiopathic Arthritis (JIA)
Juvenile idiopathic arthritis, or JIA, is chronic autoimmune arthritis that starts before age 16, with joint swelling lasting six weeks or more and no other cause. The child has morning stiffness, warm swollen painful joints, and a limp or reluctance to use an arm or leg. Oligoarticular JIA involves four or fewer joints, is the most common type and carries the highest risk of uveitis. Systemic JIA brings a high spiking fever every day with a fleeting salmon-pink rash. JIA uveitis is often silent, with no red or painful eye, yet can cause cataracts, glaucoma and vision loss, so regular slit-lamp eye exams are needed even without symptoms. NSAIDs are given with food and ease pain without preventing joint damage. Methotrexate is given once a week, never daily, with folic acid, blood count and liver monitoring, and no alcohol or live vaccines; fever, sore throat, mouth sores or unusual bruising on it are reported. Biologics such as etanercept need a tuberculosis test first and raise infection risk. A warm bath in the morning, swimming, night splints and staying in school support the child, and growth is monitored.
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