Juvenile Idiopathic Arthritis
At Dr. Kunal Mahajan Children’s Hospital, we provide specialized services for the diagnosis, treatment, and management of juvenile idiopathic arthritis (JIA). JIA is the most common form of arthritis in children, characterized by chronic joint inflammation that persists for at least six weeks and begins before the age of 16. Our dedicated team of pediatric rheumatologists, orthopedic surgeons, physical therapists, occupational therapists, and support staff is committed to delivering comprehensive and compassionate care to children with JIA and their families.
Diagnosis: Accurate diagnosis of JIA is essential for initiating timely treatment and preventing long-term joint damage and disability. Our experienced pediatric rheumatologists conduct thorough evaluations, including medical history assessments, physical examinations, and diagnostic tests, to identify and classify the subtype of JIA based on the International League of Associations for Rheumatology (ILAR) criteria. Diagnostic tests may include:
Laboratory Tests: Blood tests, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC), rheumatoid factor (RF), antinuclear antibody (ANA), and HLA-B27, may be performed to assess for markers of inflammation, autoantibodies, and genetic factors associated with JIA.
Imaging Studies: Imaging tests, such as X-rays, ultrasound, or magnetic resonance imaging (MRI), may be used to evaluate for joint inflammation, synovial hypertrophy, cartilage damage, bone erosions, or other structural changes in affected joints.
Joint Aspiration: Joint aspiration or synovial fluid analysis may be performed to obtain a sample of synovial fluid from inflamed joints for analysis, including cell count, differential, culture, and crystal examination, to rule out infectious or inflammatory causes of joint symptoms.
Classification: JIA encompasses several subtypes with distinct clinical features, disease courses, and prognoses. The main subtypes of JIA include:
Oligoarticular JIA: Oligoarticular JIA is the most common subtype, characterized by involvement of fewer than five joints during the first six months of disease onset. It often affects the knees, ankles, or wrists and may be associated with uveitis (eye inflammation) in some cases.
Polyarticular JIA: Polyarticular JIA involves five or more joints during the first six months of disease onset and can be further classified into rheumatoid factor-positive (RF+) or rheumatoid factor-negative (RF-) subtypes based on the presence or absence of RF antibodies. It often affects the small joints of the hands and feet and may lead to symmetric polyarthritis resembling adult rheumatoid arthritis.
Systemic JIA: Systemic JIA is characterized by arthritis and systemic inflammation, including fever, rash, lymphadenopathy, hepatosplenomegaly, and serositis (inflammation of internal organs), and may be associated with elevated inflammatory markers (ESR, CRP) and systemic complications, such as macrophage activation syndrome (MAS).
Enthesitis-Related Arthritis (ERA): ERA is characterized by inflammation at the entheses (the sites where tendons or ligaments attach to bone), commonly affecting the lower extremities, pelvis, or axial skeleton, and may be associated with enthesitis, arthritis, uveitis, or inflammatory bowel disease (IBD).
Psoriatic JIA: Psoriatic JIA is characterized by arthritis and psoriasis (skin rash), nail changes, or a family history of psoriasis, and may involve asymmetric joint involvement, dactylitis (swelling of fingers or toes), or nail pitting.
Treatment: Treatment for JIA aims to alleviate symptoms, control inflammation, prevent joint damage, preserve function, and improve quality of life for children with arthritis. Our hospital offers a comprehensive range of treatment options for JIA, including:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or naproxen, are commonly used to reduce pain, inflammation, and stiffness in children with JIA and may be used as first-line therapy for mild to moderate disease.
Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as methotrexate, sulfasalazine, or hydroxychloroquine, are prescribed to suppress immune-mediated inflammation, slow disease progression, and induce remission in children with moderate to severe JIA or polyarticular disease.
Biologic Therapies: Biologic agents, including tumor necrosis factor (TNF) inhibitors (such as etanercept, adalimumab), interleukin-6 (IL-6) inhibitors (such as tocilizumab), or interleukin-1 (IL-1) inhibitors (such as anakinra), target specific inflammatory pathways and are used to treat refractory or severe JIA unresponsive to conventional therapies.
Corticosteroids: Corticosteroids, such as prednisone or methylprednisolone, may be prescribed as short-term bridge therapy to control acute flares of arthritis, uveitis, or systemic symptoms in children with JIA, but long-term use is generally avoided due to the risk of adverse effects.
Physical Therapy and Occupational Therapy: Physical therapy and occupational therapy play essential roles in managing JIA by promoting joint mobility, muscle strength, flexibility, coordination, and functional independence, and may include exercises, splinting, orthoses, or adaptive equipment.
Intra-articular Injections: Intra-articular corticosteroid injections may be performed to deliver localized anti-inflammatory therapy directly into inflamed
