Known as JIA for short, juvenile idiopathic arthritis has many different forms, but it is basically a chronic inflammatory condition of the joints. Juvenile means it is a kind of arthritis that begins before the age of 16 and idiopathic means the cause is not known.
What is the incidence?
Every year about one in 10,000 children in Ireland are diagnosed with JIA, according to Arthritis Ireland. It is estimated that there are 1,200 to 1,400 under-16s with the condition.
What are the typical symptoms?
Persistent joint pain; early-morning stiffness; redness, swelling and heat over the joint. With any child presenting with those kinds of symptoms, you immediately think infection or injury first, and a lot of patients will have short-lived, reactive arthritis at the start of an illness, says Dr Emma MacDermott, consultant paediatric rheumatologist in Children’s Health Ireland at Crumlin. “But if things are persisting, then you need to start thinking about an inflammatory condition.”
Inflammation of the middle layer of the eye, known as uveitis, is linked to some forms of JIA.
How is JIA diagnosed?
A paediatric consultant rheumatologist will make a clinical diagnosis, as there is no one definitive blood test for it. However, blood work and MRI scans will be used in the diagnosing.
How is it treated?
A range of different medications are used to help youngsters manage the disease. Physiotherapy and physical activity are also part of the treatment plan.
Do children grow out of it?
There are three main scenarios for patients that are seen across all types of JIA, says Dr MacDermott.
- Those who go on medication for a protracted period of time, are then weaned off and never have another issue again.
- Another group who are weaned off medication but quite quickly it’s seen that they need to go back on it and stay on it for longer.
- The third category is those who are weaned off medication and can stay off it but may have flare-ups from time to time.
The type of arthritis a child has will indicate which of these three broad categories they are more likely to fall into. The majority of patients, 60-70 per cent, “will have a rheumatologist in their adult life”, she says. And children who have JIA continue to carry that JIA diagnosis into adulthood, she adds, because the disease that develops in older people is different.
Are there enough rheumatologists to diagnose and treat these children?
We have only about half the number there should be, according to Dr MacDermott. Benchmarked against the UK, the Republic should have at least six paediatric rheumatologists and there are about three full-time equivalents, working mostly in Children’s Health Ireland at Crumlin and Children’s Health Ireland at Temple Street, with some adolescents seen in St James’s Hospital.