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What Is Juvenile Idiopathic Arthritis
JIA is currently the most widely accepted term to describe various types of chronic arthritis in children.
In general, the symptoms of JIA include joint pain, swelling,
tenderness, warmth, and stiffness that last for more than 6 continuous
weeks. It is divided into seven separate subtypes, each with
characteristic symptoms:
1. Systemic arthritis (formerly known as systemic juvenile rheumatoid arthritis). A patient has arthritis
with, or preceded by, a fever that has lasted for at least 2 weeks. It
must be documented as an intermittent fever, spiking for at least 3
days, and it must be accompanied by at least one or more of the
following:
- generalized enlargement of the lymph nodes
- enlargement of the liver or spleen
- inflammation of the lining of the heart or the lungs (pericarditis or pleuritis)
- the characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy. The individual spots of the rash are usually the size of a quarter or smaller. They are present for a few minutes to a few hours, and then disappear without any changes in the skin. The rash may move from one part of the body to another.
2. Oligoarthritis (formerly known as pauciarticular juvenile rheumatoid arthritis). A patient has arthritis affecting one to four joints during the first 6 months of disease. Two subcategories are recognized:
- persistent oligoarthritis, which means the child never has more than four joints involved throughout the disease course.
- extended oligoarthritis, which means that more than four joints are involved after the first 6 months of the disease.
3. Polyarthritis -rheumatoid factor negative (formerly known as polyarticular rheumatoid arthritis - rheumatoid factor negative). A patient has arthritis in five or more joints during the first 6 months of disease, and all tests for rheumatoid factor are negative.
4. Polyarthritis -rheumatoid factor positive (formerly known as polyarticular rheumatoid arthritis -rheumatoid factor positive). A patient has arthritis
in five or more joints during the first 6 months of the disease. Also,
at least two tests for rheumatoid factor, at least 3 months apart, are
positive.
5. Psoriatic arthritis. Patients have both arthritis and psoriasis (a skin rash), or they have arthritis and at least two of the following:
- inflammation and swelling of an entire finger or toe (this is called dactylitis)
- nail pitting or splitting
- a first-degree relative with psoriasis.
6. Enthesitis-related arthritis.
The enthesis is the point at which a ligament, tendon, or joint capsule
attaches to the bone. If this point becomes inflamed, it can be tender,
swollen, and painful with use. The most common locations are around the
knee and at the Achilles tendon on the back of the ankle. Patients are
diagnosed with this JIA subtype if they have both arthritis and inflammation of an enthesitis site, or if they have either arthritis or enthesitis with at least two of the following:
- inflammation of the sacroiliac joints (at the bottom of the back) or pain and stiffness in the lumbosacral area (in the lower back)
- a positive blood test for the human leukocyte antigen (HLA) B27 gene
- onset of arthritis in males after age 6 years
- a first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, inflammation of the sacroiliac joint in association with inflammatory bowel disease, Reiter's syndrome, or acute inflammation of the eye.
7. Undifferentiated arthritis. A child is said to have this subtype of JIA if the arthritis
manifestations do not fulfill the criteria for one of the other six
categories or if they fulfill the criteria for more than one category.
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