What is juvenile idiopathic arthritis (JIA)?
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA) is the most common, chronic rheumatic disease of childhood, affecting approximately one per 1000 children. Juvenile, in this context, refers to disease onset before age 16 years, while idiopathic refers to a condition with no defined cause, and arthritis is inflammation within the joint.
JIA is an autoimmune, noninfective, inflammatory joint disease, the cause of which remains poorly understood. It is characterized by chronic joint inflammation. JIA is a subset of childhood arthritis, but unlike other, more transient forms of childhood arthritis, JIA persists for at least 6 weeks, and in some children is a lifelong condition.
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What are the symptoms of JRA?
Joint pain and tenderness; redness over the involved joint, decreased mobility, gait disturbance or limping; fever; rashes.
Can the eyes be affected by JRA?
Yes. A condition of the eyes called anterior iritis or uveitis can occur. This is when the inside of the eye becomes inflamed. In most cases, the child will have no symptoms and the parent will have no suspicion that there is an eye problem. For this reason, the child needs to see an ophthalmologist (a medical doctor who specializes in treating diseases of the eye) for an exam to detect this inflammation.
What are the effects of uveitis on the eye?
Inflammation inside the eye will cause white blood cells and proteins to float in the aqueous fluid in the front part of the eye. Your ophthalmologist will look for this material with a special instrument called a slit-lamp. The inflammation, if untreated, can cause the pressure to rise inside the eye. Elevated pressure over a long period can damage the optic nerve and cause glaucoma. Cataract formation can occur. The cornea can become deposited with calcium and cause a scar (band keratopathy). Swelling can occur in the retina, called macular edema.
What is Still’s Disease?
The systemic variant of JRA is also known as Still's disease. The onset of the disease is generally at less than 5 years of age. Arthritis has a variable relation to the onset of the systemic disease but is usually a polyarthritis. The systemic features include fever, rash, swollen lymph nodes, and liver and spleen enlargement. Eye inflammation is generally not associated with this variant.
How can I tell if my child has uveitis?
Some patients with uveitis will have symptoms such as decreased vision, floaters, pain, redness, or light sensitivity. Importantly, most patients with early uveitis attributed to JRA will have no symptoms. For this reason, your child must be examined at regular intervals by an ophthalmologist.
Are there long term effects of uveitis?
Yes; uveitis, if untreated, can even cause blindness. Complications from acute and chronic uveitis include cataract, glaucoma, corneal band keratopathy, macular edema, and phthisis bulbi.
What treatments are available for uveitis?
Your doctor may prescribe eye drops to treat uveitis. Usually one of these drops is a corticosteroid, like prednisolone. Corticosteroids act to decrease the reaction of the immune system. When applied as an eye drop, the effect is only local, in the eye itself. Other eye drops may be given to help open the pupil and relieve discomfort. Sometimes the corticosteroid will also be given systemically or as an injection around or in the eye. Your child’s rheumatologist will also treat JRA with medication that very often complements the treatment of the uveitis.
Will the uveitis ever come back?
It may; it is important to continue to follow-up with your ophthalmologist at regular intervals to monitor the course of uveitis.
Can uveitis cause blindness?
If untreated, uveitis can lead to blindness from glaucoma, cataract, macular edema, band keratopathy, retinal detachment, and phthisis bulbi.
Which doctors specialize in the care of a child with JRA?
The treatment of JRA and its complications, such as uveitis, requires a team approach. Your child’s pediatrician is usually the best resource for information about the overall health of your child. He/she will often enlist the help of medical doctors with subspecialty training and expertise in treating children with JRA. These include a rheumatologist, an orthopedic surgeon, and an ophthalmologist, who is a medical doctor with specialty training in treating diseases of the eye. Some ophthalmologists specialize further in treating children and patients with uveitis.
caring for children with jia
Ticho Eye Associates is here to provide helpful JIA information for parents. We know it's not easy to see your child suffering, and our highly trained team is here to help you discover the best solution for your loved one. Contact our eye care center in Chicago Ridge, IL, Tinley Park, IL, or Munster, IN to book a comprehensive eye exam. We look forward to serving you and your family.