Juvenile Arthritis Explained

Released March 3, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. Now let’s listen in. (MUSIC BRIDGE) 

Trina Wilcox: Welcome to the Live Yes! With Arthritis podcast. I'm Trina Wilcox, your host for this episode. I was diagnosed at 6 years old, finally. I say that because I know for a long time, Mom and Dad had been trying to figure out what was going on with their kid. And I feel like a lot of you might be able to relate to that. And speaking of being diagnosed young, juvenile arthritis is something we're going to talk about today, commonly known as JA. There are still so many people that don't realize kids get arthritis. In fact, there are approximately 300,000 kids and teens across the U.S. who have some type of juvenile arthritis. 

So, in this episode, we're going to go on a journey, talk about the basics of JA, sort of a JA 101 type episode to help us develop our understanding of JA. We'll answer: What is JA? What causes JA? How will juvenile arthritis affect my teen, my child? What are the treatments? And more. So, we've got some great ladies here to help answer those questions. I'm joined by not one but two pediatric rheumatologists, Dr. Julie Campbell and Dr. Amanda Moyer. Dr. Campbell is a pediatric rheumatologist at Logan Health in Montana and the first full-time pediatric rheumatologist in the state of Montana. Dr. Moyer is an adult and pediatric rheumatologist, and is Oklahoma's only full-time pediatric rheumatologist, serving as interim division chief of pediatric rheumatology at the University of Oklahoma, OU Children's Health. Welcome to the podcast. 

Dr. Julie Campbell: Thank you so much for having us. 

Dr. Amanda Moyer: Great to be here. 

Trina Wilcox: Tell me a little bit about each one of your own experiences with arthritis, juvenile arthritis specifically. Dr. Campbell, we'll start with you. 

Dr. Julie Campbell: Sure, yeah. I don't personally have juvenile arthritis. I'll just put that out there right off the bat. But I've had now almost six years of taking care of kids with juvenile arthritis through my fellowship and then my practice, and then I was exposed to it first back in medical school. I really didn't know that kids got arthritis. And as soon as I learned more about it, I realized how impactful it could be on kids' lives. I was quickly entranced with the field of rheumatology. I've taken care of so many kids now with JA. 

Trina Wilcox: I'm glad you are. Thank you. Dr. Moyer? 

Dr. Amanda Moyer: I came to know a little bit about it early in my life because I had a form of arthritis associated with an autoimmune disease as well and quickly became one of those people who wanted to learn everything about it. So, I went to medical school, decided to specialize in rheumatology and now am hopefully able to help these kids the way that doctors helped me when I was younger, too. 

Trina Wilcox: Glad you're both helping us out. Well, let's start with one of the more obvious questions. What is juvenile arthritis? 

Dr. Julie Campbell: We actually typically call it juvenile idiopathic arthritis in the medical community. It used to be called, and you'll still hear it sometimes called by non-rheumatologists: juvenile rheumatoid arthritis. But that name has changed to have a little bit of a broader umbrella and to really make the point clear that you don't have to have positive labs to be juvenile arthritis or juvenile idiopathic arthritis. And what idiopathic means is we don't know what causes it. It's just a big term to capture all kids who have arthritis and help us kind of figure out what to do next and how to classify things. 

Dr. Amanda Moyer: And I would say, JIA has a lot of different flavors. Some of our types of arthritis affect more so the small joints, like in your hands or your feet. Other types of arthritis like to affect your back or maybe the tendons and things like that throughout your body. But all types of arthritis that we treat within rheumatology are really characterized by inflammation. That inflammation can cause pain, redness, swelling and ultimately really impact the way our children are able to live their lives. 

Trina Wilcox: We've heard so many times that there are so many kinds and types of arthritis, and the same goes for JIA. There's several kinds. Can you touch on some of those and explain what the key symptoms and effects are? Dr. Moyer, we'll start with you. 

Dr. Amanda Moyer: When it's a condition that we treat within rheumatology, the main characteristic signs are inflammation. And that can be demonstrated by swelling or puffiness at that joint. It can be demonstrated by, like, redness or tenderness, and then really affecting quality of life and range of motion. And then inflammatory arthritis, or inflammatory joint pain, tends to be worse in the mornings. So, a lot of times people will wake up feeling almost stiff or it takes them a lot longer to get out of bed or get moving. It tends to actually get a little bit better with activity. Or once someone does get moving and get going and loosens up, that makes it better. And then it responds to medications that help target that inflammation. 

So, medications that reduce the inflammation make inflammatory pain better. In kids, it can present uniquely, depending on the age of that patient. A lot of times your 2-year-old can't really tell you that their joint is painful or swollen or even hot, but they don't want to walk anymore. Or maybe you notice that the 7-year-old isn't able to run around and play with their friends like they normally do. Or maybe you just notice they start walking with a limp. Kids don't always know how to say they're in pain or know how to express that, which is why it's really important to see a pediatric rheumatologist who can help sort through those things and identify the inflammation of JIA. 

Trina Wilcox: Do you have anything to add, Dr. Campbell? 

Dr. Julie Campbell: Dr. Moyer is 100% right on with all the different things that it can show up as. And each kid is a little bit different. It can show up in just one joint — the knee is the most common joint for that — but it also can show up in just the ankle or just the wrist. And then one tricky place that it can show up is the jaw. It doesn't swell in the same way that a knee would, and so sometimes that gets missed. And when it's four or fewer joints, we call that oligoarticular JIA, oligo just meaning some or few. And then sometimes it can show up in many joints, like I've seen 40 or 50 joints involved in some kids. When it's five or more joints, then we call it polyarticular juvenile idiopathic arthritis. And that can either be rheumatoid-factor-positive or rheumatoid-factor-negative. 

In juvenile arthritis, you can have lots of abnormal labs or you can have completely normal labs and still have arthritis. Then we have some other types, too, that we consider. There's enthesitis-related juvenile idiopathic arthritis, which involves more of the spine and the back and sometimes the hips. And those are also places that it's hard to pick up swelling certainly, but you can see limited range of motion and then especially a pain in the morning. That is more common in boys than some of our other types, but it can definitely happen in girls, too. Then there's, of course, juvenile psoriatic arthritis. Oftentimes that's associated with psoriasis, but about 50% of kids with juvenile psoriatic arthritis have the arthritis come first. And you don't have to have the rash to be classified as juvenile psoriatic arthritis, but there's some other features that can put you in that category. 

And then finally, we always, in medicine, have to have a grab bag. We don't exactly know how to put a label on you, and so we just call that undifferentiated JIA. And then there's kind of its own unique thing of systemic juvenile arthritis; it's kind of its own beast. It tends to have pretty intense fevers and some pretty impressive rashes that go along with it as well. And kids can get fairly sick fairly quickly sometimes with systemic JIA, and we treat it a little bit different. 

Dr. Amanda Moyer: The main manifestations that we see in that systemic form are those fevers and rash at the beginning. A lot of our other conditions that we treat in rheumatology, like lupus or even things like vasculitis, which is just inflammation of the blood vessels, can also cause joint pain and swelling or arthritis. So even though it doesn't fall under that bucket of JIA, it's certainly inflammatory arthritis that we, as pediatric rheumatologists, are very good at recognizing and treating. 

Trina Wilcox: While we're talking about systemic JIA, is that a little more involved then altogether than the other types or just different how it's treated? 

Dr. Julie Campbell: I would say it is a little bit more involved just because those kids end up... It's not uncommon for them to end up in the hospital because they do have such high fevers, and their fevers are almost always every day. And sometimes they can even, you know, lose weight or have some involvement of their organs. They just get sicker a little bit quicker. Whereas normally the other forms of arthritis don't typically involve the whole body as much. This can definitely cause full body inflammation. 

Trina Wilcox: When these symptoms start developing — especially the younger the kid is, like you said, a lot of times they can't really express what they're feeling — how do Mom and Dad, or whoever the caretaker is, how do they know to get to a pediatric rheumatologist? 

Dr. Amanda Moyer: If you see a joint that's swollen, and it's been swollen for a while — so, it's not something that just comes on right after you have an injury and just lasts for a week or so and goes away. The type of arthritis that we see and treat are really more chronic conditions. Any sort of joint pain, redness, swelling that's just not going away, or suddenly they don't really want to walk anymore, or they're having a lot of trouble getting around or doing the things that their peers are doing, those would all be really good reasons to go see the regular doctor who can help get you plugged into a pediatric rheumatologist if they're finding some of those signs and symptoms. 

Dr. Julie Campbell: There can be bad days and better days, but there's never 100% normal days before you're diagnosed with juvenile arthritis. So, swelling for a day or two that goes away for a couple weeks and then comes back, that's not the classic picture for juvenile arthritis. 

Trina Wilcox: What are some of the other conditions, autoimmune or otherwise, that come along with having JIA? I know fatigue is talked about big time, but what else can you let us be aware of? 

Dr. Julie Campbell: Probably the main thing that we worry about is uveitis in kids. It's a fairly unique thing to juvenile arthritis. There's some forms of adult arthritis that can definitely have uveitis and iritis as well. But for especially younger kids, we have them see the eye doctor quite frequently. The younger you are when you're diagnosed, the higher risk you are. 

Dr. Amanda Moyer: The complicated thing with uveitis, or that inflammation of the eye, is that you can have inflammation in the eye and your joints are completely fine. So, in our patients, we may be having those children go see the eye doctor every three months to make sure that they don't have inflammation in their eye. 

Dr. Julie Campbell: It's a hard thing, too, with that eye inflammation, is… Unlike the joints, oftentimes it doesn't cause symptoms. You certainly don't get red eyes very often or painful eyes or even blurry vision until it's really progressed far, so we want to try to catch it as early as possible to treat it. 

PROMO: The Arthritis Foundation provides essential support to families living with juvenile arthritis, or JA, and other childhood rheumatic conditions — through education, resources and community connections. We offer programs and events that bring families together, fostering a sense of belonging and shared experience while encouraging emotional well-being. See what’s available at arthritis.org/ja. 

Trina Wilcox: So, we've got the diagnosis. Let's talk about treatment. What do we do when we have the JIA? 

Dr. Amanda Moyer: Luckily, in this day and age, we do have a lot of options when it comes to treatment. And we have good treatments. Well, some of it kind of depends on that flavor of JIA that you have. If it's primarily affecting kind of the small joints, if you have positive antibodies with it, or if it's mainly affecting the back, all of that helps guide our treatment in terms of what the best options are. And once we know the type of arthritis, that can really help guide our treatment and therapy moving forward. 

Sometimes we can just use medications like NSAIDs — so, naproxen, which is the same thing as over-the-counter Aleve, is a good medicine for some forms of our arthritis cases. A lot of times we need something more, though, so we can do things, like if we have just one big, swollen knee that's involved, sometimes we can put steroids, which are really good anti-inflammatory medications, directly into the knee and help treat the arthritis that way. 

Dr. Julie Campbell: And then we also have many systemic medications or medicines that you take either by mouth, or by injection, unfortunately, that do a really good job of treating. And gosh, we probably have over 20 medicines now, I would say, for juvenile arthritis, which is incredible. Oftentimes some of what we choose is dependent on insurance coverage, which is a little bit frustrating, but there's a lot of movement and push by organizations like the Arthritis Foundation to try to give more flexibility to providers and families to be able to pick what's right. 

If you don't do well on NSAIDs, or a steroid injection isn't the right treatment or hasn't worked for you, we're looking at a medicine like methotrexate or leflunomide, are a typical first-line. And then beyond that, we're looking more into the biologics, medicines like Humira, Enbrel. Some of the newer oral medicines, like Xeljanz and Rinvoq, have really been awesome, for little kids especially, but also for older kids. And then yeah, a bunch of other ones, too. 

Dr. Amanda Moyer: And as parents look up some of these medications, especially ones like the methotrexate, that is kind of our first-line. We have the most data and the most information and have been using that one for the longest time. And like Dr. Campbell said, a lot of times insurance makes us use that one in the very beginning. But I always, always counsel that when you look it up, know that the doses that we're using for arthritis and in rheumatology are very, very different from the doses where methotrexate is used in conjunction for like chemotherapy for cancer. It is a completely different medication at the doses that we're using it. So, I really try to reassure everyone that it's a different medicine than what they may read about on the internet, because it is used in high doses with other medications to treat certain forms of cancer. 

Trina Wilcox: Excellent point. 

Dr. Julie Campbell: The way I always talk about it with families is, you know, methotrexate for cancer at these doses of a thousand milligrams or more sometimes is really trying to knock out the cancer, wipe out all of those cells; you don't want any to remain. Whereas we're using a tiny dose, no more than 25 milligrams, typically. And so, we're just trying to bring the immune system down just one notch to get rid of that attack on the joints that's going on. 

Trina Wilcox: Let's talk about surgery. I know that some folks are going to have to face that. Lot of times you need to wait until you're grown. What is your advice when it comes to talking about surgery in JIA? 

Dr. Amanda Moyer: In this day and age, we don't have to have that conversation very much. It is a rarity. Our expectation is to use the medications that we have available to effectively treat the inflammation in the joint, treat that immune attack on the joint, prevent chronic and permanent damage, and get the kid back to doing all the normal kid things. It is a really rare thing that we actually have to even think about or talk about surgery. And that's what we're trying to avoid by seeing these kids early and treating appropriately upfront. 

Dr. Julie Campbell: One of my main mentors, Dr. Helen Emery, who has been around since basically the founding of pediatric rheumatology, said a huge part of her training was about rehabilitation and joint replacement and figuring out when, how to, you know… just keep kids moving as much as possible with the limited choices they have. And we just don't do that anymore. The world has changed. But there are some cases where the disease is really significant, or unfortunately, as you experienced Trina, the symptoms get missed. And so sometimes it can go on for long enough before they come to see us that we are talking about some small surgeries to kind of keep things moving or release contractures or basically where the joint gets stuck kind of in a position. And then very rarely we're thinking about joint replacement. But as you said, that will be very much more when they're fully grown. We really want to try to avoid surgery on growing kids as much as we can. 

Trina Wilcox: So, with the new medications, it sounds like we're able to get these kiddos into remission sooner? Or is that just a different term from controlled? 

Dr. Julie Campbell: To me what remission means is that I don't feel any joint swelling on exam when I see my patients, that they really don't have much stiffness or at least less than probably 15 minutes in the morning. Their joints are moving in the way that I would expect them to. And ideally that they don't have pain, although pain is a little bit tricky with arthritis. Sometimes you can have inflammation without pain and sometimes you can have pain without inflammation. Swelling is probably the biggest thing. 

And if you're in remission, then that would mean the disease is in control, I would say. And sometimes that means you're on medication, and sometimes we are able to get kids off medication, too. I usually tell folks that about a third of kids are able to eventually grow out of their juvenile arthritis and not need medications long term. But the other two-thirds of kids may need medication all the time, or at least some of the time, throughout their life. And it is, unfortunately, difficult to predict who's going to be in what camp. But the number one goal is at least remission on medication, and then we explore the possibility of remission off medication after that. 

Trina Wilcox: Dr. Moyer, anything to contribute? 

Dr. Amanda Moyer: No, that's kind of how I like to phrase it to my patients as well. The type of JIA that you have does kind of help me predict how likely it is for you to be able to come off medication versus not. We don't have a cure per se for our types of arthritis at this point in time. But we have very, very good treatments to where we anticipate and expect our patients to be able to live their life however they were planning to before a diagnosis of arthritis. 

Trina Wilcox: A term parents and kids might hear a lot is flare. So, what does that mean in the medical sense? We'll start with you, Dr. Moyer. 

Dr. Amanda Moyer: A flare just means there's an increase of disease activity. That might mean that you're having increased joint pain, increased joint inflammation. In the case of our systemic JIA patients, with fevers and rash and all of that. So, a flare really just means an increase in that disease activity or an increase of inflammation. 

Trina Wilcox: Dr. Campbell? 

Dr. Julie Campbell: Yeah, I completely agree. The tricky thing about flares, and the more I learn about juvenile arthritis every day, is they're a little unpredictable. And everyone can present a little differently. My initial thought about flares were these have to last for at least a couple weeks to be a true flare. But I have been humbled. And you can definitely have your arthritis kind of go up and down. It's not common for it to last for just a couple hours, I would say. But there are periods where it can kind of flare for a couple days and then get back down. And sometimes that means we need to change up medications. 

Sometimes flares can come after things like illnesses, especially like colds and things like that. The body's already revved up trying to fight this infection — and the immune system is a little excitable — is how I think about it. And it sometimes goes back to its old habit of trying to attack the joints. And if we can calm things back down temporarily, sometimes we can get back to that medicated remission state. But sometimes flares just happen, and there's no rhyme or reason to that. They look a little different for every kid. 

Dr. Amanda Moyer: I've definitely been humbled as well. 

Trina Wilcox: Yeah (laughter), it has a mind of its own. Let's talk about mental health. How does JIA affect that? And how can a parent or guardian keep an eye on that or know to get help for the person they're helping take care of? 

Dr. Julie Campbell: This is a tough one because, similar to flares, the mental health impacts of JIA are different in every kid, too. I have some kids who just seem to be pretty non-bothered by it, and they just go about their lives. And then some kids, it's really impactful. I think, in general, having a chronic illness as a child is not something that most kids are expecting to have and certainly most parents aren’t expecting their kids to have. And that adjustment period can be really tough. Dealing with medicines every day or every week, of dealing with having to go to the doctor all the time, of getting blood work regularly, of being in pain. 

It's not fun. It's not good for your mental health. It's not uncommon for kids to struggle. And I try to assure them that this is normal, and you're not alone in this struggle. And it's OK, because even kids without chronic illness struggle with depression and anxiety, too. And so, just trying to figure out how we can support things and try to at least turn down the volume, I would say, of the struggle. 

Dr. Amanda Moyer: We know that rates of things like anxiety and depression are higher in our pediatric population with JA. And there is a lot of work being done to figure out how to best support that. You can't really separate mental health from physical health. They both definitely play on and affect each other. I think that's where organizations like the Arthritis Foundation are helpful, to let people know that they're not alone. And then I also make sure to counsel parents as well. I have a lot of parents that come in and are feeling so guilty. And one of the things I always make sure that they leave the appointment knowing is that nothing they did caused this in their child; nothing they didn't do caused this in their child. It's honestly a combination of probably some genetic predisposition, some environmental factors and a good chunk of bad luck. 

Trina Wilcox: Dr. Campbell, do you have any recommendations on that as well? Because it usually… JIA or any chronic condition impacts the whole family. So, what can you recommend in dealing with all of the things that come along with it? 

Dr. Julie Campbell: Some of it's a little bit family specific, but I think one thing that's important is just trying to give yourself grace and make sure that you have support both within your family and then outside your family that you can turn to for days when times are tough. Trying to connect with somebody else who has a kid with JA or for patients to find other people who have JA or kids who have JA. I had the privilege last year of being able to attend the JA Family Summit in Salt Lake City. I was truly blown away by watching the kids connect with each other and the parents connect with each other. To recognize that they are all going through the same struggles in different ways every day, and seeing everyone in kind of the spectrum of their journey that there are better days ahead, and there's many ways to get through things. So, I think that is one opportunity. 

But there's so many other ways to connect with families either in your local area, across the country or across the world really with JIA. There are definitely days with arthritis when it's active or even when it's not, where your body just doesn't feel as good and to take breaks. But then on the flip side of that, that exercise is actually really important, too. Just going for walks, doing activities that you love. Moving your body is really helpful for both physical and mental health. I can't express that enough. 

Trina Wilcox: You're walking right into my next topic, which is self-care. When it comes to exercise, I always call that my non-negotiable, but pushing too far is the negotiable. So, you get out there and move where you can, and then go with the disease in the direction that works for you. Do you have any other self-care tips that would help you co-exist with your JIA a little bit better? Dr. Moyer? 

Dr. Amanda Moyer: Good sleep is really, really important. Making sure that you're practicing good sleep, good sleep hygiene, and kind of helping your child do that as well, so limiting screen time. We know that you hurt more when you're tired. We're actually learning more and more about how the immune system doesn't function like it should when you are sleep-deprived. 

Trina Wilcox: Dr. Campbell, can you think of any more? 

Dr. Julie Campbell: Finding joy and not be afraid to find a therapist. If you want to learn French, you're going to hire a French tutor. If you want to learn coping skills, you should go see a therapist. And it's not a point to be embarrassed about. It's not something to, you know, feel like you've failed if you're going to see a therapist. They are, like, truly experts at helping us feel better and be able to cope with the things that life throws our way. 

Trina Wilcox: I'm thinking, too, for a lot of these young folks, like I was young with it, and you may be fine for a while, but you're not prepared for some of the changes from the secondary osteoarthritis or the other comorbidities that come along with it. Whatever you need, let that be flexible, and be willing to ride that wave. As much as your flare is willing to attack you when you're not ready, you attack back whenever you need to. 

Dr. Julie Campbell: Yeah, that's great advice. 

Trina Wilcox: I think regular checkups. Lifestyle modifications can be helpful, too. I know that I carry scissors and a letter opener with me everywhere I go so I can open my mail or just make those stressors a little less once in a while. 

PROMO: Have a great idea for the Live Yes! With Arthritis podcast? Emailing us to suggest topics is a great way to contribute to the conversation. Share your thoughts with us at [email protected]. Your ideas can help shape future episodes and ensure we address the interests and needs of the arthritis community. Play an active role in helping us create arthritis resources. Email us at [email protected].  

Dr. Julie Campbell: Trina, you did bring up food and diet. That's one thing we get a lot… or at least I get a lot of questions about. I'm sure you do as well, Dr. Moyer. We don't really have great studies on kids and nutrition and what is better or best for juvenile arthritis. Part of that is that kids are a little funny when it comes to food, and they trade lunch at school, and they forget that they had a snack when they went over to their friend's house. And it's just unpredictable exactly what they're eating every day. The things that we do know is … avoiding processed foods when you can, knowing that some days it's going to go out the window, and that's OK. And then, you know, trying to follow somewhat more of a Mediterranean diet and lots of fruits and vegetables as much as you can get it and good lean protein. Things like that is really helpful. To have kids grow and get the nutrients they need and then also develop a good and fun relationship with food. Because food should be fun. It's a big part of our day and a big part of our life. 

Dr. Amanda Moyer: We should all be eating a healthy diet that's low in processed foods and heavy on fruits and vegetables and whole foods. We should all be getting some exercise and good sleep and making sure that we have those coping behaviors. Most of those, honestly, is what we should all be doing, but it's probably even more important to someone who has a chronic disease. 

Trina Wilcox: When a child or a teen with JIA gets to that point where they're grown, what do they do with their care and their treatments and their access to care? How does all of that change? 

Dr. Amanda Moyer: I see adult and pediatric patients. And that transition period of time can be really, really difficult and stressful. So, making sure that we, as pediatric rheumatologists, and even pediatric primary care physicians, are helping prepare that child to take ownership of their health as they grow up. That's really, really important. But then even our adult rheumatologists, understanding that an 18-year-old probably does still not have a developed frontal lobe and may not be any more of an adult at that stage in their life as a 12-year-old is. And having some grace for that patient when they transition to adult care. 

And then in many of our pediatric clinics, we have support, like case managers or social workers, that can help set that patient up for success. From the parent perspective, it can be really hard to kind of let your kids start to do some of that themselves, but I think it's really, really important to kind of partner with the child's physician or doctor to help them develop that skill. 

Trina Wilcox: Dr. Campbell, should I still write down JIA, JRA or RA when I'm putting my forms down? When they say, "Do you have any conditions?" 

Dr. Julie Campbell: That is a great question, Trina. I actually had an 18-year-old yesterday who was like, “I just saw a new adult doctor for GI. And they were like, ‘What is JIA? JRA?’” And I was like, “Yeah, you know, that's tough.” I think for your rheumatologist, you should be as specific as possible, so that they have a sense of, oh, yeah, like, “This did not start when I was 22. This started when I was young.” For your primary care provider, ideally, they would also have that understanding. For better or for worse, sometimes you'll have to be the teacher because there are going to be some adult providers who don't know a lot about juvenile arthritis, and so you can help tell them. But I think it's not wrong, once you turn 18, to say that you have, you know, rheumatoid arthritis or ankylosing spondylitis or psoriatic arthritis, depending on what's going on with your body. But I would put somewhere at least that it's juvenile, so they know this is not a new thing for you. 

Dr. Amanda Moyer: I actually tend to give both diagnoses. So, if it's a pediatric onset form of arthritis that has an adult counterpart, which most of them do, I will leave both diagnoses on that patient chart. Because I do think it's important that your adult providers know that this started in childhood, because arthritis that starts in childhood does come with a few other things that we need to think about. Like, the risk of eye inflammation is a lot higher in pediatrics and doesn't necessarily go away into adulthood as you grow, although that risk does decrease. Or the risk of arthritis involving the jaw is a lot more common in our pediatric population than it is our adult population. So, I tend to leave both diagnoses on the chart and kind of counsel my patients that they should list both as well because it helps us know, from my adult rheumatology lens, what are some of the things I need to be looking for a little bit more in this patient because they were diagnosed when they were young. 

Trina Wilcox: Thank you for clearing that up. I’ve always wondered. I’m like, “I’m not a juvenile anymore.” But like you’re saying, it does give the background and the history right there. It’s juvenile onset, for lack of a better descriptor. 

One of the things that we like to do is to post a question on social media. And for this episode, we asked: "What's one thing you really wish you knew about juvenile arthritis when you or your child was first diagnosed?" And Mindy Morrison Fitzgerald says, "How complicated arthritis is in kids. Definitely keep an eye on mental health, especially around the age of puberty. Be willing to think outside the box and try holistic medicines as well as traditional treatments. You never know what will end up working for your child." Any thoughts on that? 

Dr. Amanda Moyer: I think keeping an eye on the mental health is really, really important. And a lot of clinics that you go to will screen for anxiety and depression or have handouts for that. I do recommend certain kind of complementary therapies as well in certain people, but if you're taking a lot of vitamins and supplements, just make sure the rheumatologist knows about that, because there actually are some that are marketed as immune support or immune boosting that we want people to avoid. Because in JIA or arthritis, the immune system being kind of extra active or hyperactive is part of the problem. So, we don't want patients taking supplements that help stimulate the immune system more, because honestly, we're usually trying to calm it down. 

Trina Wilcox: Right. Dr. Campbell? 

Dr. Julie Campbell: Yeah, I completely agree with what Dr. Moyer said. There's a lot more research that needs to be done on some of the complementary and holistic therapies to see what can be helpful, because I think there is a place for that in our world and in our therapy. We know vitamin D, for example, is really important. And turmeric probably has a role there, you know, has a place. There can be too much of good things, too. And so, just talking through with your rheumatologist and your doctor what are you on to make sure that everything is safe and good for your treatment is really helpful. 

Trina Wilcox: Jill Buckelmeyer Norman says, "The pediatricians need more background knowledge of what to look for and when to refer. My son went undiagnosed for years, causing permanent joint damage in his toes." We kind of touched on that. A lot of times the parents are big advocates for their kids and need to know when to push. And they will push. What do you do when that physician's not listening? 

Dr. Julie Campbell: Ask for a second opinion, I would say. (laughs) 

Dr. Amanda Moyer: Yeah. There are just not enough pediatric rheumatologists right now. Both the Arthritis Foundation as well as the organizations like the American College of Rheumatology are all trying to increase our workforce. The more people that we can get into pediatric rheumatology, the better. 

Trina Wilcox: Katie Weaver Morrow says she wants people to know there is hope. "The beginning is hard, and it feels like your child's never going to be without pain. But with time and the right medication, living without pain is possible. And also, finding the right medication can be a long and frustrating process. The give-it-time period can feel like forever, and sometimes side effects are brutal, making you question if you're doing the right thing for your child." 

Dr. Julie Campbell: I very much resonate with what Katie is saying here. As a doctor, I feel these things. And I can't imagine as a parent feeling these things, watching it every day. Because we do have to give medicines time, usually about three months, to kick in to fully kind of change how the immune system is working, to get a sense of is this going to be the right medicine. Some of these medicines can have side effects. They don't for everyone, but we do try to at least warn people and troubleshoot them as much as we can. It is somewhat trial and error, and then also certainly working with insurance companies to do what they want us to do sometimes. 

Trina Wilcox: Catherine Hudson says, "How important it is to find your person. Find another mama or daddy who has a similar age kiddo with arthritis. The JA Family Summit is an excellent way to meet your person, as no one else, and I mean no one, will understand what you're going through and how much your life has changed after diagnosis. I know the Connect Groups are also a great way for people to connect." 

Dr. Amanda Moyer: Yeah, finding your support, finding your people, is really, really important. And all of this is so much harder if you feel like you're alone. 

Dr. Julie Campbell: And if there's not a lot going on in your community right now with the Arthritis Foundation, you can be the change. You can start doing stuff. When I came to Montana, it's just me as a pediatric rheumatologist. I'm still trying to get my feet and figure out how to do things. But we've started doing some events over the last year, and they've been really successful and really fun. And I've had a couple of really invested families that have been super helpful at getting things off the ground. 

PROMO: Looking for expert guidance on living well with arthritis? The Arthritis Foundation offers a collection of free e-books covering a wide range of valuable topics to support daily living with arthritis. From strategies to simplify everyday tasks to travel advice, smart nutrition choices and more, these resources are designed to empower you. Explore the topics that matter most — and take charge of your health. Download your free e-books today at arthritis.org/ebooks. 

Trina Wilcox: To close each episode, we try to share our top three takeaways from each episode. I'll start with Dr. Moyer. What are your three takeaways? 

Dr. Amanda Moyer: I would say just kind of an overview of what JIA is. There's a lot of different flavors, and it can present or affect multiple people in different ways. And our job is to help figure that out and treat it. All forms of JIA are characterized by inflammation. So, that's one of the things that we assess for. Point number two, I think, speaking specifically to caregivers, I always emphasize that nothing that they did or didn't do caused this. We don't know exactly what leads to JIA, but luckily now we have a lot of good treatment options. And we really expect these kids to get back to doing all the things that normal kids do. 

And then point number three, making sure they leave that appointment with hope. So, to anyone who is new on this journey or just kind of starting this journey, I want to offer this: One day, there will be a day where you wake up, live your life, and later realize that you didn't once think about JIA. So, that is kind of where I want to help get my parents and families and patients to with a relationship in coming to see me. 

Trina Wilcox: Thank you so much. Dr. Campbell, three takeaways? 

Dr. Julie Campbell: Yeah, those are all good ones. I think my first one is that JIA can happen to anybody. It can happen to kids who have a lot of autoimmune disease in their family or no autoimmune disease in their family. It can happen to kids under 1 and it can happen up through 18 and certainly beyond. And it can happen to boys, it can happen to girls. It's a little more prominent in girls, but can happen, yeah, to anyone. And so, just because your kid may not fit the perfect textbook definition of something, that doesn't mean you shouldn't still advocate for at least getting checked out. The second thing that I would say is that it's certainly a journey, and there's going to be ups and downs and flares and remission and all the things. And just give yourself grace. Make sure you're taking care of yourself. Sleep, eat, exercise and go to therapy. 

And then the last thing I would say is that the biggest privilege of my job is getting to know families and patients over years. And this is a chronic condition. I wish there was a cure, but we do have, as Dr. Moyer said, a lot of really good treatments and a lot of hope. And we are very much on your team for that whole journey. And I feel so lucky to be able to just be a part of the JA experience and try to give kids the best lives I can. 

Trina Wilcox: Thank you so much. I think my takeaways are that I love that I have the freedom to continue writing JIA or JRA on my forms. (laughs) I like that we're all talking about the hope. I am so pleased that kids that are newly diagnosed these days don't have to go through what a lot of us have had to go through. And hopefully one of these days no one will have to. And I appreciate the resources that we have. Find your community. Find all you can out about what you're dealing with and keep your head up. You can always find more resources on arthritis at arthritis.org. Thank you all so much. I appreciate your time. 

Dr. Julie Campbell: Thank you so much, Trina. 

Dr. Amanda Moyer: Thank you. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!