JIA Beyond the Joints
By Mary Anne Dunkin
Hot, swollen joints may have been the first signs that led to your child’s arthritis diagnosis, but juvenile idiopathic arthritis (JIA) can mean more than joint involvement. Studies show that as many as one in five children with JIA have comorbidities – or other conditions that occur along with their arthritis.
Here are some of the more common possibilities and what you need to do to keep your child safe:
Uveitis, or inflammation of the eye, is the most common non-joint manifestation of juvenile idiopathic arthritis. Left untreated, it can lead to vision loss. While uveitis may cause symptoms such as blurred vision, eye pain, sensitivity to sunlight or headaches, younger children – who are more likely to have uveitis – may not be able to verbalize their symptoms, says Jonathan Hausmann, MD, a pediatric and adult rheumatologist at Boston Children’s Hospital and Beth Israel Deaconess Medical Center.
Furthermore, the most common type of uveitis in JIA – anterior uveitis, which affects the middle layer of the eye – often has no initial symptoms. For that reason, your child’s doctor will recommend periodic eye exams with an ophthalmologist, says Dr. Hausmann. If uveitis is detected, your child’s doctor will prescribe an immunosuppressive drug, such as methotrexate or another DMARD, to control it.
Pain amplification syndrome
“Any disease that causes pain like arthritis is a risk factor for the development of pain amplification syndrome – a centralized pain syndrome where nerve fibers become more sensitive to pain,” says Dr. Hausmann. Children with pain amplification syndrome may complain of frequent bellyaches or headaches, even though medical exams are normal. They may also have trouble sleeping, keeping up with school work and concentrating. If your child has pain amplification syndrome, treatment may include physical therapy, a graded aerobic exercise program and/or cognitive behavioral therapy (CBT) to help them change their response to pain. Your child’s rheumatologist may also refer your child to a counselor or pain rehabilitation program.
Anxiety and depression
Living with a chronic disease can be tough for anyone, so it’s not surprising that some kids with arthritis also struggle with anxiety and/or depression. “Kids want to be like everybody else - they don’t want to take medications, see doctors, miss school or do other things involved in taking care of their arthritis,” says Dr. Hausmann. “All of these things can take a toll on kids.” For kids who are struggling, counseling is crucial, he says. “Counseling can teach coping strategies regarding the disease, such as getting them to accept the disease and understand that they need to take medication,” says Dr. Hausmann. “It empowers them to be an active member – not ‘poor me’ but ‘I can take charge of my arthritis.’”
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is an umbrella term for diseases, including Crohn’s disease and ulcerative colitis, in which inflammation damages the digestive tract. Symptoms may include diarrhea, bloody bowel movements, abdominal pain and weight loss. IBD is more common in children with enthesitis-related arthritis (ERA) – or arthritis accompanied by tenderness in the connective tissue between the tendons or ligaments and bone. In one study, 25 percent of children with IBD also had arthritis.
Other autoimmune diseases
While rare, children with JIA may also be at an increased risk for other autoimmune diseases, most notably type-1 (juvenile) diabetes, according to a 2018 study published in the Journal of Pediatrics. Other autoimmune diseases associated with JIA include autoimmune thyroid disease and celiac disease, a condition in which eating gluten leads to small intestine damage. Research shows that using DMARDs reduces the risk of type-1 diabetes in adults with RA, which suggests that aggressively controlling JIA may also help prevent diabetes –and perhaps other comorbidities.
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