There is no single test to diagnose JIA in children and teenagers. Since JIA may be a part of many different illnesses, it is important to exclude those other conditions. The doctor will do a complete evaluation to make sure the joint pain and swelling are not due to some other cause. It may take some time for the doctor to make sure that a child has JIA. The doctor will also need to determine what type of JIA the child has.
Here are the main steps involved in making a diagnosis:
The doctor will hold a detailed interview with the child. The doctor will ask a lot of questions. This is to obtain a complete history about her health and symptoms. The doctor will ask about past health conditions, any tests that have been done, any medications or treatments that she has used, and how well any of these treatments have worked for her. This health history helps to determine how long her symptoms have been present. It can also help rule out other possible causes.
The doctor will want to know if any other family members have arthritis. Some forms of arthritis can be inherited, meaning that they can be passed down from generation to generation.
The doctor will do a complete physical exam, which is an examination of a child's entire body. During the exam, the doctor will check to see if any joints are inflamed. Symptoms of joint inflammation may include joint swelling, limited movement, or pain on movement.
Certain types of JIA are associated with rash, eye problems, or inflammation of the internal organs. The doctor will check for these during the physical exam. A child may also need to see an eye doctor for a more specialized eye exam.
The doctor will probably order some laboratory blood tests. These may include:
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- antinuclear antibody (ANA)
- rheumatoid factor (RF)
- human leukocyte antigen (HLA)
- hemoglobin and blood count testing
- other tests if needed
These blood tests are explained on the 'Blood Tests' page of this resource centre.
X-rays and related imaging studies
The doctor may order certain imaging studies to help with diagnosis. Imaging studies provide pictures of a child's bones, joints, and organs. They can help check for other possible causes of arthritis. Examples include:
- bone scan
- bone density test
- magnetic resonance imaging (MRI)
These imaging tests are explained on the "X-rays, Bone Scan and Bone Density," and "MRI" pages of this resource centre.
Physical Treatments for Juvenile Idiopathic Arthritis (JIA)
Physical methods like heat, cold, touch, and exercise can help to reduce pain. These strategies can help improve a child or teenager's overall sense of well-being. They can improve her ability to do the things she wants to do. Physical treatments can be used on their own for the treatment of pain. Usually, however, they are used in combination with other pain-relieving methods.
Heat is helpful when dealing with pain due to stiffness. Applying heat increases blood flow. Heat feels soothing, and it can help relieve stiffness in a child or teenager's muscles and joints.
Here are some ways a child or teenager can use heat:
- Use a hot water bottle, heat pack, or heating pad/blanket.
- Rub on heating lotions or gels.
- Have a warm bath or shower.
- Do exercises in a hot tub or warm swimming pool.
- Use paraffin wax baths for sore hands, feet, and elbows.
It is important to be careful when using heat to avoid burns. Never fall asleep on a heating pad
For some people, cold is a favourite way of dealing with pain. Cold is really helpful for soothing red, swollen joints. Cold gives a natural numbing effect. It numbs the nerve endings in the affected areas. Cold can also help to reduce swelling and inflammation by slowing blood flow and decreasing the activity of cells in the body.
Here are some ways a child or teenager can use cold:
- Use a frozen gel pack wrapped in a towel.
- Try a plastic bag filled with ice or frozen vegetables (peas) wrapped in a towel to avoid freezing the skin.
- Use a cold cloth or compress.
- Rub on menthol-based gels or lotions.
It is important to be careful when using cold to avoid freezing the skin.
Heat and cold provide short-term pain relief. Some people find it helpful to alternate between using hot and cold for swelling, muscle spasms, and sore joints. Twenty minutes on and then 20 minutes off is a good rule of thumb when using both heat and cold.
Massage or rubbing is another way to help manage pain. Massage can stretch and loosen stiff muscles and help decrease stress. Rubbing a sore joint will help to block the pain signals from reaching the brain.
Here are some ways a child or teenager can use massage:
- Get a massage from a massage therapist. While this will help to relax the entire body, it probably is not possible to have this done very often, as your insurance might only provide limited coverage.
- Rub the child's sore joints for her. If you are a teenager with JIA, have someone rub your sore joints.
- Do self-massage by rubbing the painful areas.
- Use a back massage device or massage pillow.
Gentle, regular exercise can help protect a child or teenager's joints and muscles from further injury. Exercising helps to build muscle which can provide her joints with more support. If a joint is surrounded by strong muscles, then there is less stress on the joint when it moves than if those muscles are weak and thin. Regular exercise can also help maintain a child's ideal weight which helps to reduce the pressure on her joints.
Exercise encourages healing in injured or inflamed areas and can improve energy level and mood. Exercise also releases her body's own natural pain-relieving substances called endorphins.
Stretches/range of motion exercises help reduce stiffness and help keep the joints and muscles flexible. Range of motion is the normal amount the joints can move in certain directions. Stretching gradually expands that range, leading to less pain and stiffness. In order to help decrease stiffness, stretching exercises should be done regularly, not just on the day that the child is stiff or sore. She may find that she likes to do stretches while having a hot shower or bath.
It is important to find a type of exercise that a child enjoys, like swimming, yoga, or walking her dog. She can build up slowly from there.
A child might feel like doing nothing if her joints hurt and she cannot do her normal exercise routine. She may also want to be alone and just take it easy. This makes sense when she has pain that lasts a short time. However, with JIA pain that keeps coming back, she can end up spending too much time by herself. This can leadher to feel lonely, down, and stressed out. A child should not let her pain keep her from doing the things she wants to do, especially being with other people.
After exercising, a child may have a bit of muscle or joint soreness. A little soreness is normal, but severe soreness is a sign that she has done too much. It is important for a child to push her body, but she should not exhaust herself. If she has extreme soreness, reduce the intensity or length of the exercise and then gradually build up again. This is called pacing. It is better fora child to pace herself and give about the same amount of effort each day rather than do too much one day and nothing the next day.
The doctor and physiotherapist can provide you with education and instruction on ways to stay active during a painful flare.
As yet, there is no cure for JIA in children and teenagers. However, there are safe and effective medications to help control the disease. These medications can help:
- decrease the inflammation
- decrease pain and swelling
- make it easier to stay active and exercise
- prevent or lessen damage to the joints
In this section of the JIA resource centre, you will learn about the medications that may be prescribed for JIA.
A medication program will be designed by the doctor. The choice of medications to use is very specific to the child. It will take into account things like the type of JIA he has, how severe his JIA is, and other medical issues he may have.
Things to remember about JIA medications
- The medication needs to be taken regularly, the way the doctor prescribes it. This is the only way to be sure that the child will get the best results from it.
- The medication dose prescribed is based on the child's weight and how severe his JIA is. He should always take his medication as prescribed. Do not change the dosage without talking to the doctor first. For some medications, such as corticosteroids, a child could become ill if the dose is changed without consulting the doctor.
- Most JIA medications will need a prescription. However, some of them do not need a prescription. These are called over-the-counter medications.
- Many children and teenagers with JIA need to take more than one medication together at the same time. This is called combination therapy. It often has the best chance of controlling the disease.
- JIA medications need to be taken for a long time to be effective. JIA does not tend to "go away" in a few months. A child will probably need to take medications for many months or years.
- All medications can cause side effects. You will learn about the most common side effects later in this section of the JIA resource centre. It is important to discuss the different side effects of the medications with the doctor. He or she can provide ways to deal with the side effects.
- Make sure to tell the doctor about all treatments being taken for JIA or for any other problem. The doctor needs to know about all prescription and over-the-counter drugs. You also need to tell the doctor if other remedies are being taken, such as vitamins, minerals, supplements, or naturopathic or homeopathic therapies.
- Make sure to inform the doctor about any other coexisting medical conditions, such as asthma.
Different names for medicines
Did you know that there are often two different names for each medication? The generic name is the name of the active ingredient in the drug. The brand name is given to the drug by the company that produces it.
If two or more companies make the same drug, it may be available under different brand names or under the generic name. The active ingredient is the same for all versions of the drug. For example, ibuprofen is a generic name and Advil and Motrin are the brand names for ibuprofen.
The impact of JIA on family activities
JIA not only affects the child. JIA also impacts the entire family. The effects on the family can vary depending on the type of JIA the child has, the severity of her symptoms, treatments, and frequency of flare-ups. The level of impact that JIA has on the family can also be affected by coping styles of the parents and individual family members.
Parents might find themselves spending extra time helping the child with JIA, especially during a flare. This shortens the amount of time parents spend with other family members.
Change of plans
Family activities and plans may need to be changed or cancelled with little notice because of a flare-up in the child's JIA. Parents might want to have a "Plan A," "Plan B," and sometimes even a "Plan C" for family activities. This builds flexibility into family plans. It ensures that fun family activities can still take place. You can call this "flexible planning."
For example, you and your family decide to plan for a family outing to an amusement park (Plan A). You would like to make it a surprise but realize that it would be better for Chris, your child with JIA, to know about it in advance to be able to plan for it. You make the following plan in advance of the big day: On the day of the excursion, Chris will decide by 9:00 am whether or not he is ready and able to go. If Chris decides not to go due to an JIA flare, then a backup plan (Plan B) is in place: an adult is identified - one parent, relative, or other support - who will look after Chris and do at-home activities with him so he can still have fun while the rest of the family is away. That way everyone can enjoy themselves without a long and difficult last-minute discussion of Chris's symptoms. Plan C may include calling ahead to a theme park, to see about accessible equipment available to rent at the park if needed, if it is too difficult for Chris to walk around the park. This way he can still participate in the day and everyone can go and enjoy together.
Strategies to manage the impact of JIA on the family
There are several strategies that can help the family cope with the negative impact of JIA. Here are some tips for parents.
Learn about JIA
- Learn as much as you can about your child's JIA. Don't try to do this all at once when your child is diagnosed as this can be overwhelming. Rather, start to learn about JIA gradually. Ask your child's health care team for any written information they can give you.
- Write down questions as you think of them. Get them out of your head and onto paper; it's less overwhelming. Ask as many questions as often as you need in order to understand what's happening with your child's health.
- Look for information on credible web sites. If you find information that looks really good (such as a 'cure' for JIA) or information that is frightening to read, please share that information with your child's health care team. They can tell you whether or not it is valid and if it applies to your child.
- Write down the information you find and your questions for your child's health care team. Figure out a way to keep track of the information and appointments related to your child's care. You might want to keep all this information in a binder, to help keep yourself on top of things. Having information available in an organized way will help cut down on your stress. It can help reduce the chaos that can be associated with chronic illness and ongoing treatment.
Take care of yourself
Most parents put their children's needs and the needs of others well before their own. This is natural in times of crisis. However, parents are important too. Here are some tips to help parents.
- Take care of your own physical, mental, and spiritual needs. Not taking care of yourself can lead to physical and mental health problems, which can then make it harder to care for your child. This can have a negative effect on your child in the long run.
- Teach your child the value of self care by modelling it yourself. Remember, he looks to you to learn how to take care of himself.
- If you are finding it impossible to meet both your needs and your family's needs, find help.
- Talk to a close friend and accept offers of support. If needed, ask your doctor for a referral to a counsellor.
- Remember: take care of yourself so that you can keep your child healthy!
Consider your parenting style
Many parents make some changes in the way that they are parenting their child with JIA. Some of these changes may lead to increased communication and support for the child. Other changes in parenting may not support the child's ability to cope with JIA as well. For example, parents may lower their expectations of what their child can do; they may then have trouble encouraging better self-management in their child as the child may take on an "I can't" mentality. Parents can also feel guilty about the new demands that their child with JIA has in his life and so they may make exceptions for things like chores in the house.
- Consider the overall short- and long-term impact of JIA on your parenting style. For example, in the short term such as dealing with a flare, your parenting style may involve changing expectations for what your child can do that day. However, in the long term, you need to use your parenting style to show your child that you believe that he is capable of doing most things.
- Think of what kind of adult you want your child to become. Keep that in mind as you consider your parenting style.
- Maintain consistency and communication. These are two important strategies for parenting a child with a chronic illness.
- If you have concerns about your parenting style as it related to your child's JIA, speak to someone you trust. You can also ask your doctor to refer you to a counsellor.
Take it one day at a time
- During a flare-up or times of stress, it is easy to feel overwhelmed. Take things one day at a time.
- Focus on a manageable number of tasks, and get support from others.
- Consider how family members cope with stress. Encourage everyone to manage their stress in healthy ways. Set an example for the rest of your family.
Remember you are not alone
- Remember that you are not alone in this. Others have dealt with similar issues you are facing. They may be able to give you support and advice that can help.
- Sometimes it is helpful to talk with another parent of a child with JIA. Ask your health care team if you feel this would be helpful.
Accessing other resources
There may be other social support resources available in the community. Speak with the doctor or other members of the health care team.