The disease process of juvenile idiopathic arthritis (JIA) varies by type, disease activity (eg, flares, remission), and severity. Usually, severity of symptoms fluctuates in a series of flares (worsening of symptoms) and remissions (symptoms improve or disappear). Some children experience a permanent remission, in which the disease “fizzles out,” and some may just have a flare or two, and that’s the end of it. Others, however, may experience a more aggressive disease course, with many flares, and may have more than joint problems.

Since juvenile idiopathic arthritis is an autoimmune disease, other organs and body systems may become involved. Listed below are examples.

Spine
The spine contains vertebral bodies (bone) and joints; called the facet joints. When JIA affects the spine, some specific complications may occur.

• Polyarticular arthritis can affect the cervical spine (neck), causing pain and stiffness that can make your child uncomfortable.
• Certain types of JIA can affect the lower back (lumbar spine).
• Enthesitis-related arthritis attacks the soft tissues around the joints (ligaments, tendons, muscles, and joint capsules). One type, juvenile ankylosing spondylitis, may cause erosion of the sacroiliac joint (where the spine meets the back of the hip). Sometimes, one or more levels of the spine may fuse (bones grow together) and stiffen. It is important to exercise and maintain mobility.

View an animation about ankylosing spondylitis.

Other Joints of the Body
Enthesitis commonly affects the heel, and polyarticular arthritis can involve the small joints of the feet, hands, and wrists.

• Oligoarticular (or pauciarticular) and enthesitis-related juvenile idiopathic arthritis may affect the knee. The hips can be affected by oligoarticular JIA and spondyloarthropathy. Oligoarticular JIA can involve the shoulders and elbows, and may cause arms or legs of unequal size, since a hot, inflamed joint grows more quickly. In more than half of children with JIA, the jaw is involved. Problems with temporomandibular joint (TMJ) do not always cause symptoms, but they can result in difficulty with chewing or facial deformity.

Growth
Your child’s growth rate may be affected, either from the inflammation of JIA itself or from corticosteroids, which may be used to treat the disease.

Systemic JIA
Systemic means that the whole body may be involved. Children with systemic juvenile idiopathic arthritis may have high fever(s) (which may precede or accompany the arthritis symptoms) and rash(es), either of which may come and go quickly. Your child may develop one or more swollen lymph nodes and/or an enlarged spleen and/or liver. Sometimes inflammation develops in other organs, such as of the lining of the heart (pericarditis) or lungs (pleurisy), but these are not common complications.

Eyes
Eye problems can be severe. It is more common in oligoarticular (or pauciarticular) arthritis, particularly enthesitis-related. Iritis (inflammation of the iris) and uveitis (inflammation of the uvea, the area behind the iris) may occur spontaneously in children with juvenile idiopathic arthritis, or sometimes after the child has had the disease for a period of time. Regular eye exams should include examination under a slit lamp, which may help detect eye problems early.

Skin
Skin problems are common in many types of juvenile idiopathic arthritis. Systemic JIA is sometimes associated with a rash. A particular feature of psoriatic arthritis is dry, scaling of the skin. The finger and toe nails may be affected. Inform your child’s doctor if any skin problems emerge.

Digestive System
Spondyloarthropathy is often associated with inflammatory bowel disease. Symptoms may include diarrhea and abdominal pain.

Reproductive System
Puberty may be delayed in a child with juvenile idiopathic arthritis as the disease (JIA) may affect sexual development.

Medication-related Problems
Some medications suppress the immune system (immunosuppressants) and increase the risk of infection. If your child has swollen glands or other signs of infection and is taking one of these drugs, tell your doctor immediately. Methotrexate, one drug that may be prescribed to treat your child’s juvenile idiopathic arthritis, may cause liver damage. That is one reason why routine blood tests are required. Some medications can cause nausea or an upset stomach, and certain immunosuppressant medication can affect fertility.

JIA May Effect the Entire Family
Chronic medical problems or diseases like juvenile idiopathic arthritis can take a toll not only on the child affected, but on the family as well. Your child may be easily angered, become sad or depressed. As a parent, you may develop feelings of guilt, sadness or even anger that other family members (eg, siblings) may have too. Talk with your child’s doctor about resources, community organizations, and/or local support groups that can help you, your child, and your family.