National Bone and Joint Day: Don’t ignore joint pain in children — it could be juvenile arthritis

While lifestyle changes are bringing in more cases, it is also a fact that diagnosis of JIA has increased due to better awareness.

ByChetana Belagere

Published Aug 04, 2023 | 8:00 AM Updated Aug 04, 2023 | 8:00 AM

Juvenile Idiopathic Arthrits can affect two age groups —2-4 years and 9-12 years. (Commons)

Fourteen-year-old Rohan had put on some weight and would constantly complain of knee and ankle pain. Saritha Rajeev, his mother, thought that it was growing pains and asked Rohan to ignore them. But the pain only kept increasing and she could see visibly swollen and red joints that were warm to the touch.

Concerned, Saritha took Rohan to a paediatrician who referred them to a Paediatric Rheumatologist. Rohan was diagnosed with Juvenile Idiopathic Arthritis (JIA), an arthritic condition seen in children below the age of 16.

What is Juvenile Idiopathic Arthritis?

While the exact cause of JIA is unknown, it happens due to an immune system malfunction. In children with JIA, the immune system attacks the joint linings, causing swelling. In other words, JIA is an autoimmune disease. If untreated, it can damage the joint.

“In the past, joint pain and swelling in children was often attributed to mild infections or common injuries. However, with advances in medical research and a deeper understanding of pathophysiology, it has become apparent that children can indeed suffer from arthritis,” explains Dr Karthik Badarayan V, Consultant, Paediatric Rheumatologist, at Hosmat Hospitals in Bengaluru.

Representative pic

Juvenile Idiopathic Arthritis seen in a child. (Wikimedia Commons)

Unfortunately, the number of children coming to the out-patient departments (OPDs) with complaints of joint pains and being diagnosed with JIA has gone up in the recent past. Every week, Dr Badarayan sees at least 8-10 cases, which makes it about 30-35 cases a month.

“While it is true that lifestyle changes are bringing in more cases, it is also a fact that over the years, diagnosis of JIA has increased due to better awareness and improved medical capabilities. In the past, many cases went undiagnosed, but with current advancements, doctors can now identify and treat JIA more effectively, leading to a rise in reported cases,” notes Dr Badarayan.

Dr Sagar Bhattad, Consultant, Paediatric Immunology and Rheumatology, Aster CMI Hospital, who sees 10-15 children with JIA a month, echoes Dr Badarayan opinion on the matter. “Better awareness may be one of the reasons for increased incidence of JIA,” he says.

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At what age can JIA occur?

Dr Badarayan says that JIA can occur at a very young age too, as young as even 18 months. However, the two prominent age groups when this condition can peak are around 2 to 4 years and then again around 9 to 12 years.

The most common symptoms include joint pain, joint swelling, and restricted joint movement.

Initially, parents might attribute these symptoms to growing pains or injuries from playing, but if the pain persists and the swelling worsens, at this time, it is crucial to seek medical attention promptly.

Diagnosing juvenile arthritis

Diagnosing JIA requires careful observation and clinical assessment. Doctors say that it is usually a paediatrician who can identify this first. The paediatricians then refer the family to a paediatric rheumatologist, who are more well-learned in this area.

JIA primarily affects otherwise healthy children, with only about 10 to 20 percent of cases having a family history of arthritis.

“Most of them are extremely healthy children, with no predisposal to arthritis — as in with no family member having this condition,” Dr Badarayan says.

Blood tests and scans, like ultrasounds or MRIs, may be performed to confirm the condition and assess its severity.

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Treatment options for JIA

The good news is that JIA is treatable and there have been significant improvements in treatment options. Dr Badarayan says that earlier it was believed that once someone gets arthritis, then it is for a lifetime.

Swollen joints are a symptom of JIA. (Wikimedia Commons)

Swollen joints are a symptom of JIA. (Wikimedia Commons)

“There are several medications available based on the stage. Also, chances of the condition recurring in these children after treatment is low. It is a long-term treatment. We start with medication — both tablets and injections — and then we couple it with lifestyle changes. Physiotherapy can effectively control the disease and its symptoms. Early diagnosis and treatment play a crucial role in minimising the impact of JIA on a child’s quality of life,” Dr Badarayan adds.

Dr Bhattad adds, “Joint injections with steroids are a safe and effective method for treating JIA, along with disease-modifying antirheumatic drugs (DMARDs), like methotrexate.”

If left untreated, JIA can negatively affect a child’s growth, lead to limb length discrepancies, alter their gait, and increase susceptibility to infections due to the medication. However, with proper medical care and compliance with treatment, there is a high chance of remission, particularly in children.

Dr Badarayan says, “However, a balanced diet, regular physical activity, and a healthy lifestyle devoid of processed food may contribute to reducing the risk. Regular screening is needed if there is family history of arthritis.”

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Difference between growing pains & JIA

To differentiate between the two, it is important to know that growing pains are typically generalised. It need not be specific to the ankle, knee, etc, explains Dr KV Ananda Murthy, an orthopaedic doctor in Bengaluru. However, in the case of JIA, it is pain seen specifically in the joints.

“Along with pain, there is also swelling of the joints. There is increased temperature and the joints become red too,” explains Dr Murthy.

He adds, “Growing pains are usually experienced at night. However, children with JIA wake up in the morning with severe pain; they cannot even get out of bed. Growing pains reduce in intensity over time, but in JIA, the intensity of pain only increases,” Dr Murthy adds.