Juvenile idiopathic arthritis (JIA) is characterised by persistent arthritis of unknown cause that begins before 16 years of age and is present for at least 6 weeks after exclusion of other diseases. In Australia, JIA prevalence is between 1 and 4 cases per 1000 children.1 Almost all children with arthritis report chronic or recurrent pain with 70% restriction in physical activity. Approximately half of those with JIA have limited use of upper limbs or hands and difficulties with hand strength. Long periods of active arthritis impair muscle development, resulting in generalised growth retardation, uneven limb lengths, joint erosion and lower aerobic capacity. Unrecognised, JIA has the potential to cause long term sequelae and leave a lasting impact on the physical function, growth and quality of life of affected children.
Juvenile idiopathic arthritis is the most common rheumatic
disease in childhood, occurring in approximately 1:500
children. Despite a recent expansion in treatment options
and improvement of outcomes, significant morbidity still
This article outlines the clinical manifestations,
assessment, detection of complications, treatment options
and monitoring requirements, with the aid of guidelines
recently published by The Royal Australian College of
General Practitioners, which provide practical support
for general practitioners to ensure best practice care and
to prevent lifelong disability in patients with juvenile
General practice plays an important role in the early
detection, initial management and ongoing monitoring of
children with juvenile idiopathic arthritis. Early detection
involves understanding the classification framework for
subtypes of juvenile idiopathic arthritis, and being aware
of the clinical manifestations and how to look for them,
through history, examination and appropriate investigation.
The major extra-articular manifestations of juvenile
idiopathic arthritis are uveitis and growth disturbance.
Treatment options include nonsteroidal anti-inflammatory
drugs, methotrexate, biologic agents, and corticosteroids.
Management using a multidisciplinary approach can
prevent long term sequelae. Unfortunately, approximately
50% of children will have active disease as adults.
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