Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (RA), is joint inflammation in children 16 years of age or younger, lasting for at least 6 weeks. Unlike adult rheumatoid arthritis (RA) that is chronic and can last a lifetime without proper diagnosis or intervention, children usually outgrow JIA. But do they really?
JIA is…drum roll please…an autoimmune disease. Children with predisposed genes, such as a part of a gene called HLA antigen DR4, could be at a higher risk for developing JIA. Even if the symptoms of JIA subside, the risk of developing an autoimmune condition later in life is probable. All autoimmune conditions can be connected to “leaky gut”, a problem where the gut barrier breaks down and inflammation begins to trigger an autoimmune response. Even if your child does not have gut-related symptoms, it is quite common that those with JIA have small intestinal bacterial overgrowth, undergrowth, or other infectious bugs that must be brought under control with proper evaluation and support.
There is evidence that early exposure to antibiotics and compromised gut health could be contributing factors. Additional studies support the connection between JIA, type 1 diabetes, food allergies, and inflammatory bowel disease (IBS). Infants who were born vaginally vs. by c-section tend to have more Bifidobacterium in their gut, which is associated with a strong immune response. Nursed infants also have higher levels of this same beneficial bacteria in addition to Lactobacilli and Streptococci. Bottle-fed infants could be lacking these healthy bacteria, and may be at increased risk of developing an autoimmune disease.
There are several types of JIA:
- Systemic onset JIA affects one or more joints, combined with high fever and a skin rash. It may also cause inflammation of internal organs, including the heart, liver, spleen, and lymph nodes. It is the least common type. It affects 1 in 10 to about 1 in 7 children with JIA.
- Oligoarticular JIA affects 1 to 4 joints in the first 6 months of disease. If no more joints are affected after 6 months, this type is called persistent. If more joints are affected after 6 months, it is called extended.
- Polyarticular JIA affects 5 or more joints in the first 6 months of disease. Blood tests for rheumatoid factor (RF) will show if this type is RF-positive or RF-negative.
- Enthesitis-related JIA is arthritis and swelling of the tissue where bone meets a tendon or ligament. It often affects the hips, knees, and feet.
- Psoriatic arthritis may have both arthritis and a red, scaly skin disease called psoriasis. 2 or more of the following symptoms may be present:
- Inflammation of a finger or toe
- Pits or ridges in fingernails
- A first-degree relative with psoriasis
- Undifferentiated arthritis is arthritis that has symptoms of 2 or more JIA types above. Or the symptoms might not match any type of JIA.
Symptoms of JIA may include:
- Pain, swelling and tenderness in the joints. The joints may also feel warm.
- Morning joint stiffness
- Limping gait (younger children may not be able to perform motor activities that they recently learned)
- Weight loss
- Swollen lymph nodes
- Fatigue or irritability
- Eye redness, eye pain, and blurred vision
How do you know if your child may have JIA? A physical exam may not be enough to determine a clear diagnosis. A MRI or X-ray could show the degree of inflammation, and a comprehensive blood panel may show the presence of the substance’s antinuclear antibody (ANA) and rheumatoid factor. These tests can help rule out other diseases. As well, the most significant and accurate marker for rheumatoid arthritis, cyclic citrullinated peptides (CCP) should be run.
Functional medicine excels at this aspect of determining the root cause and how to rehab the immune system. If you suspect your child may have juvenile idiopathic arthritis, Dr. Autoimmune can help. Click the “Start Your Journey” button at the bottom of this page or call today to schedule a new patient evaluation with Dr. Ian Hollaman: 303-882-8447, press 0 to speak with Felice.