‘Juvenile Idiopathic Arthritis’ remains a puzzle
The most common type of arthritis in children called juvenile idiopathic arthritis (JIA), where idiopathic means ‘from unknown causes’, is currently imposing a formidable burden on patients and caregivers in terms of reduced quality of life and economic hardship globally. The financial burden is attributable to the cost of multiple clinic visits, laboratory tests, imaging investigations, expensive medications, occasional hospitalisation, and workabsenteeism.
It is estimated that nearly 1 in every 1000 children develops this condition. JIA can cause persistent joint pain, swelling and stiffness with some children experiencing these symptoms for only a few months, while others have symptoms for many years. While we observe July as the Juvenile Arthritis Awareness Month, we can’t help wondering that so much burden is being carried for a disease for which the causes are still unknown.
It is regarded as an autoimmune disorder where the immune system attacks some of the body’s own healthy cells and tissues. Scientists don’t know exactly why this happens or what causes the disorder in children. Some think that something in a child’s genes makes the child more likely to get arthritis, and then something else, such as a virus, sets off the arthritis.
In particular, JIA is an umbrella term for several subtypes of arthritis seen in children and adolescents under the age of 16. There are six main subtypes of JIA namely oligoarticular that involves four joints or fewer; polyarticular that involves five or more joints; systemic arthritis that begins with fevers, rashes, and inflammation in other parts of the body as well as the joints; psoriatic arthritis that involves inflammation of the joints occurring in some children with psoriasis; enthesitis-related arthritis associated with tendons and ligaments attached to bones; and an undifferentiated type that doesn’t fit into any one of the categories mentioned here.
Some forms can also cause eye inflammation. And if this condition is left untreated, it may result in cataract, glaucoma and even blindness in children. Because there is no actual test for detecting JIA, the diagnosis is often made by excluding other conditions that may cause similar symptoms, such as bone disorders or breaks, fibromyalgia, infection, lyme disease, lupus, or cancer.
The good part is that in recent years, treatment options and outcomes for patients with JIA have improved considerably. These changes have been attributed to the availability of biologic therapies and the increasing efforts to move toward a treat-to-target approach in JIA management.
In addition, the creation of large paediatric research networks has improved patient access to, and design of, clinical trials for rare paediatric diseases. Although these advances have resulted in improvements in care for most patients, certain subgroups of patients continue to have a poor prognosis. For instance, a number of patients with polyarticular disease are still refractory to multiple treatments, and, more recently, some patients with systemic JIA are developing a form of interstitial lung disease, which is a cause for concern.
Medications such as nonsteroidal antiinflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologic agents, corticosteroids are prescribed for the treatment but these drugs can interfere with normal growth of the children and increase susceptibility to infection.
As an alternative, acupuncture is considered to help a child handle some of the stress of living with an ongoing illness. The National Institutes of Health (NIH) in the US considers acupuncture an acceptable additional treatment for arthritis. Studies show it eases pain, may lower the need for painkillers, and can boost flexibility in affected joints. But it doesn’t stop joint damage from getting worse with some forms of JIA.
Consequently, scientists are of the view that incorporation of novel biomarkers in combination with validated clinical measures in an effort to predict outcomes and target therapy accordingly could come out as an exciting development. Moreover, the use of personalised medicine can be explored to help use the right drug for the right patient at the right time.