Juvenile Arthritis (cont.)

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What are complications of juvenile idiopathic arthritis?

Perhaps the most insidious and most devastating complication of JIA is iritis. The risk for iritis is variable depending upon the subtype of JIA. The highest risk group is oligoarticular JIA while patients with systemic onset JIA are at a low risk of this complication. It is imperative that all JIA patients have thorough ophthalmologic examinations in order to detect any changes that would herald the onset of iritis.

Another common complication of JIA is growth disturbances (such as a difference in leg lengths). Interestingly, the involved joint (such as the knee) has an increase in blood flow due to the inflammatory nature of the local arthritis. This increase in blood flow encourages the area of bone growth (growth plate) to maximum activity and thus the involved leg is longer than the non-involved limb. However, as the disease progresses, the chronic nature of arthritis can damage the growth plate region causing premature fusion and thus the involved leg will be retarded relative to the uninvolved limb. Many patients experience moderate pain of the joints involved resulting in limited use of the region. As a result, loss of calcium from the bone can result in osteoporosis.

These children and their parents may also fall victim to emotional stress associated with any chronic illness. Long-term low-grade pain may stimulate a sense of helplessness and hopelessness and thus depression. Children often have a limited social life (especially with their peers) due to school absenteeism.

It must also be remembered that the medical therapies commonly used to treat JIA can have many have prominent side effects (see below).

What is the prognosis of juvenile idiopathic arthritis?

Approximately 50% of children with JIA continue to have active disease into adulthood. In patients who have who have active disease into adulthood, there can be significant disability with functional limitations. Outcome may reflect duration of disease, presence of polyarticular involvement, and the need for systemic steroids. In the United States and Canada, death is rare (29 out of 10,000 patients) and is most likely in those patients with systemic onset JIA.

REFERENCES:

Espinoza, M., and B. Gottlieb. "Juvenile Idiopathic Arthritis." Pediatrics in Review 33 (2012): 303.

Lehman, T. "Classification of Juvenile Arthritis." UpToDate.com. Sept. 4, 2012.

Prakken, B., S. Albani, and A. Martini. "Juvenile Idiopathic Arthritis." Lancet 337 (2001): 2138.


Medically Reviewed by a Doctor on 8/21/2013

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