The Sunday Times MediScene - JIA: When a pain in the joints could be something more

Arthritis is a disease that we commonly associate with the aged. Yet Juvenile Arthritis or Arthritis which occurs in children before the age of 16 is also a fairly common condition. For some children Juvenile Arthritis is fairly mild and doesn't cause a significant impact on their lives, while for others it can be a disabling condition with considerable pain and limitations in mobility and daily activities.

While there are several different types of arthritis in children, 'Juvenile Idiopathic Arthritis' (JIA) is the most common, according to Dr. Saman Jayanetti, Consultant in Rheumatology and Rehabilitation, Lady Ridgeway Hospital.

The term 'idiopathic' is used because there is no underlying demonstrable cause for the disease - it appears that for some reason the immune system becomes confused, and releases chemicals which cause inflammation. Heredity may be a reason, but on its own it does not seem to cause JIA. The factors that trigger the disease are unknown.

Arthritis, says Dr. Jayanetti, refers to inflammation of joints. The main symptoms of JIA are pain in the joint or joints, difficulty in movement and sometimes, swelling in and around the joints.

JIA is difficult to diagnose because its symptoms are easily confused with other illnesses. However, if a child has persistent pain in the joints for over 6 weeks, JIA should be suspected, says Dr. Jayanetti. This is since joint pain that is caused by viral flu, rheumatic fever or other such illnesses usually does not last for more than 4-6 weeks.

Also, since the symptoms of Systemic Arthritis - a particular type of JIA - closely resembles that of Leukaemia that should first be ruled out, he adds.

Of course, joint pain does not always have to mean Arthritis, he says. For instance 'Growing Pains'-or the pains that occur in the calves and thighs particularly at night, or 'Hyper Mobility Syndrome'-which affects any joint that has been overstretched, are also conditions which arise in growing children.

The good news is that the majority of children with JIA can be cured if diagnosed early, and continue to live normal lives. Medications are available that both decrease the symptoms of joint pain and stiffness and alter the disease process, preventing permanent damage to the joint or joints. Appropriate medical therapy depends on the category of JIA and extent of joint involvement.

Late diagnosis on the other hand, may lead to deformities in the child's limbs. Another complication of JIA, says Dr. Jayanetti, is uveitis (or inflammation of the eyes), which if not diagnosed properly can lead to blindness or impaired vision.

He also stresses on the importance of continued treatment by a qualified doctor which can be from a few months to several years. Special care should be taken when steroids are indicated for the treatment of JIA, he says, since these can cause side effects such as facial and bodily swelling, diabetes, cataracts, growth retardation and osteoporosis. Steroids should only be taken for a short period of time.

For some children JIA may be cured permanently, but for a few there is a chance of recurrence in adulthood.

JIA is categorized into 5 main types based on the number of joints involved during the first 6 months of disease and the involvement of other organs.

* Oligoarticular - This is the most common type of JIA and is defined as the involvement of fewer than 4 joints. This type often includes uveitis (inflammation in the eyes).

* Polyarticular - When there is arthritis in 4 or more joints.

* Systemic arthritis - This is characterized by high fevers, rash, and inflammation of other organs, in addition to arthritis.

* Enthesitis related-This involves pain in the insertion of the ligaments and occurs mainly in boys older than 8 years.

* Psoriatric arthritis - This includes children who have arthritis and may develop psoriasis rashes later on.