Juvenile Idiopathic Arthritis

Abstract About 1 in 1000 children in the United States develops chronic arthritis, mostly juvenile idiopathic arthritis (JIA). There are many types of JIA, including JIA involving a few joints (oligoarticular) or many joints (polyarticular, both rheumatoid factor negative and positive subsets); psoriasis-related; enthesitis-related; and systemic. Several comorbid conditions may exist in children with JIA, including eye inflammation (uveitis), destructive temporomandibular joint (TMJ) arthritis, and macrophage activation syndrome (MAS), the last occurring primarily in those with systemic JIA. Fortunately, frequent screening of children with JIA by ophthalmologists, combined with improved uveitis therapeutics, has resulted in a dramatic reduction in cases of blindness resulting from uveitis. Similarly, TMJ arthritis is detectable by magnetic resonance image screening prior to symptoms. The advent of biological therapies targeting proinflammatory cytokines (tumor necrosis factor [TNF], interleukin-1 [IL-1], IL-6) has markedly improved outcomes of all forms of JIA and MAS. Early and aggressive therapy can result in normal childhoods for children with JIA.