Juvenile idiopathic arthritis (JIA) is the name for a group of chronic inflammatory conditions that cause arthritis in children under the age of 16. It is the most common form of arthritis in children and one of the most common chronic childhood illnesses in Australia.
The name reflects three key features of the condition:
-
- Juvenile – onset before age 16
- Idiopathic – the cause is unknown
- Arthritis – inflammation of the joints
JIA is an autoimmune condition, meaning the immune system mistakenly attacks the body's own joint tissues, causing ongoing inflammation, pain, and swelling. There are several different subtypes of JIA, each with its own pattern of joint involvement and set of symptoms.
The outlook for children with JIA has improved significantly. With early diagnosis and appropriate treatment, many children with JIA will go into remission – sometimes permanently – and most will not have active symptoms by the time they reach adulthood.
How Common is JIA?
At least 5,000 children in Australia are living with JIA at any one time, with a prevalence of approximately 1 to 4 per 1,000 children. This makes JIA roughly as common as childhood diabetes in Australia.
JIA can develop at any age under 16 and affects both boys and girls, though rates vary by subtype. Some subtypes are more common in girls, while others such as enthesitis-related arthritis are more common in boys.
Symptoms vary depending on the subtype of JIA and the child, and can fluctuate between flares (periods of worsening) and remission (periods of reduced or no symptoms). Common symptoms include:
-
- Joint pain, swelling, tenderness, warmth, and redness – most often in the knees, hips, hands, and feet
- Morning stiffness or stiffness after rest that improves with movement
- Fatigue and persistent low energy
- Fever and generally feeling unwell, particularly in systemic JIA
- Loss of appetite or unexplained weight loss
- Skin rashes (in some subtypes)
- Limping or reluctance to use a limb, especially noticeable in young children who may not be able to communicate their pain
- Eye inflammation (uveitis) – can occur with few or no symptoms and can lead to vision problems if not monitored and treated
JIA symptoms can be easy to miss or mistake for growing pains. If a child has joint swelling or persistent pain lasting more than six weeks, they should be assessed by a doctor.
The exact cause of JIA is not known. It is thought to involve:
-
- Immune system dysfunction – the immune system mistakenly attacks healthy joint tissue, triggering chronic inflammation
- Genetic factors – JIA tends to occur more often in families with a history of autoimmune conditions, and certain genes (including HLA-B27 in ERA) are associated with specific subtypes
- Environmental triggers – viral or bacterial infections may trigger the onset of JIA in genetically susceptible children
JIA is not contagious and cannot be passed from one child to another.
There is no single test for JIA. Diagnosis involves a combination of:
-
- A detailed medical history of the child and family
- Physical examination of affected joints
- Blood tests – including inflammatory markers (ESR, CRP), rheumatoid factor (RF), anti-CCP antibodies, and HLA-B27 gene testing. Note that blood tests can be normal even in active JIA – a normal result does not rule out the diagnosis
- Imaging – X-rays, ultrasound, and MRI to assess joint inflammation and damage
- Eye examination – to check for uveitis, which can be present without symptoms
If JIA is suspected, your child's GP should refer them to a paediatric rheumatologist – a specialist in childhood arthritis. Reaching a diagnosis can take time due to the fluctuating nature of JIA, but early referral and diagnosis leads to significantly better outcomes.
Treatment aims to reduce inflammation, relieve symptoms, protect joints, and support the child's normal growth and development. Management involves a multidisciplinary team including a rheumatologist, physiotherapist, occupational therapist, ophthalmologist, and often a psychologist or school support worker.
Exercise and physical activity: Regular physical activity is essential and strongly encouraged. Low-impact activities such as swimming, cycling, and yoga are ideal. An individually tailored physiotherapy program can help maintain joint mobility and muscle strength.
Self-management and family support: Pain management techniques including heat and cold therapy, relaxation, and gentle stretching can help between medical appointments. Children with JIA should be supported to participate in school and social activities as normally as possible.
Medications
NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen are used for pain and inflammation relief in mild cases. Corticosteroid injections into specific inflamed joints can provide significant short-term relief, particularly in oligoarthritis.
Conventional DMARDs (disease-modifying anti-rheumatic drugs) are typically the first step when NSAIDs are insufficient. Methotrexate is the most commonly used option and is effective across several JIA subtypes; others include hydroxychloroquine and sulfasalazine.
When conventional DMARDs haven't adequately controlled disease, biologic DMARDs are used. These target specific parts of the immune system and must be prescribed by a specialist. Types include TNF inhibitors, IL-6 inhibitors, and T-cell inhibitors.
JAK inhibitors (Janus kinase inhibitors) are a newer class of oral medications targeting specific immune pathways, used when other treatments have been insufficient.
The following specialty medications are available at Ace, a specialty pharmacy for Juvenile Idiopathic Arthritis.
Biosimilars of adalimumab and etanercept are available on the PBS. Speak with your Ace pharmacist about your options.
With Ace, you’ll benefit from:
-
- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
There are many organisations that support Australian children and families living with JIA.
Support Organisations
Clinical & Research Resources
