“It’s a very subtle presentation,” Dr. Sule said. Often, the disease manifests itself with the child wanting to be picked up just after waking up in the morning and after naps, because they’re stiff, she noted.
The polyarticular form affects girls more than boys by a three-to-one margin and is usually seen when children are either very young or in their teens. It tends to affect the knees, ankles, wrists and hands. Dr. Sule said it’s important for clinicians to monitor a child’s growth, in addition to their joints.
Systemic JIA can present at any age and is equally prevalent in girls and boys. It includes a fleeting, salmon-colored rash, which can come and go with fever. “If you don’t see it [the rash] the first time, go back and back and back,” she said.
‘It’s very important to start this process early, to start talking to children & their parents about this planned process of transition from as young as ages 11 to 14.’ —Dr. Sule
The disease typically involves a “quotidian fever,” that is, a fever spike followed by hypothermia once or twice a day. This pattern is not typically seen in other causes of fever, so it makes sense to keep track of this, Dr. Sule said.
Anterior uveitis is a particularly important issue to monitor in JIA, especially because it involves no symptoms.
“It’s very important to recognize that these children need to be screened,” she said. In oligo- and polyarthritis JIA, screening for anterior uveitis should be done every three to four months through age 7, then every four to six months. Yearly screenings are acceptable in systemic JIA, since these children are not at an increased risk.
One key difference between children with JIA and adults with rheumatoid arthritis is that children tend to be able to live disease free without treatment much more commonly than adults, Dr. Sule said.
Transitions
Dr. Sule also stressed the importance of transitioning children from their pediatric rheumatologist to an adult rheumatologist over a period of time, rather than all at once, so the young adult can become versed in their disease and medications and can develop self-management skills. It’s helpful for the pediatric rheumatologist to prepare a medical summary for the adult rheumatologist, she said. “Get acquainted” visits with the adult physician can be helpful as well.
“It’s very important to start this process early, to start talking to children and their parents about this planned process of transition from as young as ages 11 to 14,” Dr. Sule said, “so that it’s a process of development—not just that they turn 21 and at their last visit they’re seen by the pediatric rheumatologist and told to find an adult rheumatologist.”
