• Oligoarticular JIA

    The word ‘arthritis’ literally means inflammation of the joints. Arthritis that affects children under the age of 16 is known as juvenile idiopathic arthritis, or JIA, and in the UK there are around 15,000 children with some form of JIA.

    ligoarticular JIA (also known as oligoarthritis) is the most common type of JIA. It affects four joints at most, although in a few children and young people, more joints can be affected in time (after about six months of symptoms); this is called extended oligoarthritis.

    Of all children with some form of arthritis, about 1 in 3 will have oligoarticular JIA. It tends to affect more girls than boys, and usually starts before the age of six.

  • Why does arthritis occur?

    It is not clear exactly what causes arthritis, and different types of arthritis may have different causes. (The word ‘idiopathic’ means of unknown cause.) JIA is thought to stem from a combination of genetic and environmental factors and an immune system disorder. It is extremely rare for more than one family member to be

  • Symptoms

    The symptoms of oligoarticular JIA can include:

    • Limping, showing discomfort or complaining when trying to stand or walk, especially in the morning
    • Pain and swelling in joints, particularly the knees and/or ankles, which lasts for more than six weeks
    • Eye inflammation (uveitis) in the clear area (and the inside) of the eye

    This is painless and not associated with redness so it is important that your child has specialist eye examinations to detect and treat it early.

  • Diagnosis

    There is no definite test to diagnose oligoarticular JIA, and diagnosis can take a while. Your child will see a specialist with experience of arthritis in children and young people. Oligoarticular arthritis is diagnosed on medical history and symptoms and by examination, not on blood tests, although your child may be sent for x-rays to exclude other causes of joint pain.

  • How will it affect my child?

    Oligoarticular JIA affects different people in different ways, but it is common to experience pain, stiffness and fatigue. Typically, there will be times when the symptoms of arthritis improve or even disappear (referred to as going into remission), and times when they worsen (known as flare-ups).

    Flare-ups tend to be unpredictable and can be made worse by other infections. Your child will need regular blood tests and check-ups to monitor for signs of inflammation. It can be difficult to know what an infection is and what is a flare-up, so if you are at all concerned you should seek medical attention.

    Oligoarticular JIA differs in form and severity from one child to another. Your child may experience one or two episodes that settle with treatment, or have relapses and need intermittent treatment, or need ongoing treatment into adulthood and be at risk of joint damage.

  • Treatment

    Although there is no cure for arthritis, there are many effective treatments that can enable your child to live a happy and healthy life. Medication for arthritis in children has improved a lot in recent years, and ongoing research is improving our understanding of the condition all the time.

    Medication for oligoarticular JIA can include:

    • Non-steroidal anti-inflammatory drugs (nsaids) such as ibuprofen or diclofenac to reduce pain and inflammation, taken in tablet or liquid form
    • Steroids to reduce inflammation, either by injection into the joint or by drops into the eye to reduce eye inflammation
    • Disease-modifying anti-rheumatic drugs (dmards) such as methotrexate to stop arthritis progressing, taken in tablet or liquid form or by injection

    It is important that your child takes all medication as directed by your doctor but if you or your child does have problems or concerns, never hesitate to discuss these with your healthcare team. As your child grows up it is increasingly important that they are also involved in this shared decision-making process.

    Some children experience side effects from medication, but the risks of these need to be balanced against the risk of untreated arthritis, which can lead to permanent joint damage.

    Physiotherapy and regular exercises are also an important part of treatment for oligoarticular JIA. The use of hot and cold packs, warm baths and gentle massage may all help reduce your child’s pain or discomfort.

  • Your child’s healthcare team

    You and your child will come across numerous health and care professionals. Which specialists you meet and how they work together will depend on your child’s particular needs and circumstances, as well as on the way healthcare services are structured in your region. Some of the key ones are:

    • General practitioner (GP)
    • Rheumatology consultant
    • Specialist nurse
    • Occupational therapist (OT)
    • Physiotherapist
    • Podiatrist
    • Orthotist
    • Ophthalmologist
    • Orthopaedic consultant
    • Psychologist

    You will meet some of these people regularly over several years, often acting as a link between them, sharing information and chasing up actions. Developing good, positive relationships with them can be hugely beneficial.

  • Transition

    As your child grows up, it is important that they begin to take charge of their own healthcare, including managing their arthritis. As they get older they will be encouraged to see their healthcare team members on their own or at least for part of their visit. This will help them begin to look after their own medication, and to become more knowledgeable and more involved in decision making around their arthritis and treatment.

    This move into adult healthcare services is sometimes called transitional care and usually starts in early adolescence. It can feel like quite a leap, because adult healthcare usually involves seeing different doctors and nurses, often in different hospitals.

    If your child’s arthritis has been diagnosed in a pediatric rheumatology service and they are still requiring rheumatology care in their mid-teens, the rheumatology team will also discuss with them and you about the transfer of their care to an adult rheumatology service. Research has shown that when young people and their careers are well prepared for this move they find it easier to cope in the new situation.