Chronic health conditions
Jackie Musgrave in Health and Wellbeing for Babies and Children, 2022
Juvenile Idiopathic Arthritis (JIA) is one of the most common causes of disability in children. It affects 1 in 1,000 children which means that around 12,000 children in the UK have JIA. We are not sure exactly why some children get arthritis, but it occurs when the immune system attacks the lining of the joints causing pain and inflammation. The aim of treatment is to get the condition under control and for the child to return to normal activities. It is important to note that children can have ‘flares' of arthritis even after being well for some time. A flare happens when symptoms get worse or reoccur after being successfully treated. They can occur after infections, stress or treatment changes but the cause may not be known. Some children may grow out of arthritis, but some will continue to have symptoms into adult life.
Advanced therapies and future treatments
Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen in Practical Uveitis, 2017
This is actually an easier question to answer than it first appears. If it is regarded that this therapy is selectively powerful with fewer side effects but is very expensive the groups that it will benefit the most will be obvious. First in line will be children with juvenile idiopathic arthritis (JIA) as preventing side effects in this young group is vital to their long-term vision and general health. Another group includes those with conditions that traditionally require heavy systemic immunosuppression such as Behçet's disease, where an early referral to a rheumatologist for biologic therapy will save time and sight. The third group consists of patients with severe uveitis of any aetiology who have gone through the conventional algorithm of oral steroids and a steroid-sparing agent or even two but the disease for whatever reason is not tamed and the patient continues to deteriorate even though their body is being poisoned with drugs. In certain parts of the country there may be a fourth group consisting of adults with milder uveitis who could use standard immunosuppression, but whose knowledge of Google, angry letter writing skills and inability to perceive the nature of a socialist healthcare system such as the National Health Service (NHS) results in a belief that they are entitled to biologic therapy. Biologics can be regarded perhaps as a steroid sparing agent as they are given to reduce dependency on other more toxic drugs.
Major Histocompatibility Complex and Autoimmune Disease
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of chronic childhood arthritides in children below sixteen years of age and persisting for at least six weeks and having no known cause.75 It includes clinically distinct forms of juvenile arthritis, which have genetic associations with different alleles of HLA class II. The most common form, oligoarticular arthritis, is defined as arthritis affecting four or less joints. The other forms are the extended oligoarthritis, polyarticular arthritis, divided in rheumatoid factor (RF) positive and negative, enthesitis related arthritis, psoriatic arthritis and “other arthritis”. The polyarticular form is defined by affecting five or more joints in the first six months. For the oligoarticular form of the disease, a significant disease susceptibilty exisits for the HLA-haplotypes DRB1*08-DQB1*0401-DQB1*0402 and DRB1*11-DQA1*0501-DQB1*0301.76,77 The class II genes HLA-DRB1*01 and DRB1*04 have been reported to increase the risk of polyarticular arthritis. DRB1 *04 has a particuarly high association with IgM rheumatoid factor-positive polyarticular arthritis, whereas DRB1*01 is associated with oligoarticular disease onset that converts to a polyarticular disease.8,79 Analysis of the distribution of the DPB1 alleles showed an increase in DPB1*0201 in the oligoarticular form of the disease.77,80,81
Evaluating the use of JAK inhibitors in inflammatory connective tissue diseases in pediatric patients: an update
Published in Expert Review of Clinical Immunology, 2022
Jane Chuprin, Lindsay McCormack, Jillian M. Richmond, Mehdi Rashighi
Juvenile Idiopathic Arthritis (JIA) is the most common pediatric rheumatic disease, affecting approximately 70 per 100,000 children [9–11]. Systemic JIA (sJIA) is a more complex form of JIA and can present with arthritis, uveitis, lymphadenopathy, fever, rash, hepatomegaly, splenomegaly, and/or serositis [9]. Systemic JIA accounts for 10% of all JIA in North America, accounting for as high as 50% in some Asian nations [9]. Due to its various complications and chronic immunosuppression, it has the highest mortality rate of JIA subtypes. Treatment regimens for sJIA typically include nonsteroidal anti-inflammatory drugs, glucocorticoids, and/or DMARDS. More recently, biologic therapies have improved outcomes for patients with JIA by targeting interleukin-1 and interleukin-6, pertinent cytokines to the pathogenesis of arthritis [9]. As Huang et al. note, these biological therapies involve frequent subcutaneous injections or infusions and can be logistically difficult for young patients and their families.
Update on the management of uveitis in children: an overview for the clinician
Published in Expert Review of Ophthalmology, 2019
Lucas Kim, Alexa Li, Sheila Angeles-Han, Steven Yeh, Jessica Shantha
Future directions include an improved understanding into the risk factors underlying pediatric uveitis to allow clinicians to predict which patients are at higher risk of developing vision-threatening ocular complications. Because uveitis can often present asymptomatically in children, it is important to identify and stratify those at risk for developing uveitis so that treatment can be promptly initiated. Prognostic factors have been studied mainly in JIA, and factors such as male gender have been correlated with an increased risk of specific ocular complications including cystoid macular edema, cataracts, and papillitis in JIA-associated uveitis [78]. The Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study found that young age of JIA disease onset and ANA positivity were significantly associated with the onset of uveitis (P < 0.001) [79]. Furthermore, laboratory markers such as erythrocyte sedimentation rate (ESR) ≥20 mm/hour and S100A12 levels ≥250 ng/ml have demonstrated an association with an increased risk of uveitis onset [79]. Age of onset of uveitis (<5 years) and active disease as measured by the clinical Juvenile Arthritis Disease Activity Score (>4.5) have also been correlated to uveitis reactivation [80]. Further research in identifying other demographic risk factors or laboratory biomarkers may help clinicians to better distinguish children at highest risk for developing vision impairment in the future.
The frequency of macrophage activation syndrome and disease course in systemic juvenile idiopathic arthritis
Published in Modern Rheumatology, 2020
Mustafa Çakan, Şerife Gül Karadağ, Ayşe Tanatar, Nuray Aktay Ayaz
Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children [1]. The diagnosis of JIA is made by the presence of arthritis for more than 6 weeks in a child younger than 16 years of age and in whom there is no other identified cause for arthritis [1,2]. JIA is a heterogeneous group of disorders having arthritis as a common feature. Several classification systems were developed for JIA and the last one, International League of Associations for Rheumatology (ILAR) classification, divides JIA into seven subtypes as systemic, oligoarthritis (persistent or extended), rheumatoid factor (RF)-positive polyarthritis, RF-negative polyarthritis, psoriatic arthritis, enthesitis-related arthritis (ERA) and undifferentiated arthritis [2]. Frequency of each subtype seems to be affected by ethnicity, immunogenetic susceptibility and environmental factors. While oligoarthritis is the most common subtype in developed countries, ERA is presented as the most common subtype in developing countries [1,3].
Related Knowledge Centers
- Ankle
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- Polyarthritis
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