Joint pain

September 2010

FocusJoint pain

Juvenile idiopathic arthritis

Volume 39, No.9, September 2010 Pages 630-636

Christina Boros

Ben Whitehead

Background

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 occurs.

Objective/s

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 idiopathic arthritis.

Discussion

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.

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.

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Correspondence afp@racgp.org.au

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