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OUTLINE
• Introduction
• Definition and Types
• Epidemiology
• Etiology and Risk Factors
• Signs and Symptoms
• Diagnosis
• Treatment
• Complications and Prognosis
• Physiotherapy Treatment of Juvenile Arthritis
• Conclusion

Juvenile arthritis
• is a chronic autoimmune condition that affects children and
adolescents under the age of 16.
• It is characterized by joint inflammation, pain, and stiffness, which
can lead to long-term disability if left untreated.
• JIA ranges in severity. It affects the joints, as well as other structures
such as the eyes, skin, and organs.

• Juvenile arthritis is a broad term that encompasses several subtypes
of arthritis that occur in children.
• The most common form is called juvenile idiopathic arthritis (JIA),
previously known as juvenile rheumatoid arthritis (JRA).

Epidemiology
• JIA is the most common chronic heterogenous rheumatologic
condition in children.
• It is estimated that around 3 million children and young adults have
JIA. The global prevalence is believed to range from 3.8 to
400/100,000; the incidence is estimated to be 1.6 to 23/100,000.
• Females are at higher risk of JIA than males.
• The oligoarticular subtype is more common.
5

ETIOLOGY
• The exact cause of juvenile arthritis is unknown.
• a combination of
 genetic, a role, as certain genes have been associated with an
increased risk of developing the disease.
environmental,
immunological factors, dysregulation of the immune system,
specifically autoimmunity.

RISK FACTORS
• A family history of autoimmune diseases
• Genetic
• Exposure to infections or other environmental triggers
• Females

TYPES
1. Oligoarticular JIA:
Involves fewer than five joints in the first six months of disease
onset.
 It often affects the large joints, such as knees and ankles
is more common in girls.
2. Polyarticular JIA:
Affects five or more joints in the first six months of disease onset.
 can be further divided into rheumatoid factor (RF)-positive or RF-
negative subtypes based on the presence of a specific antibody.

3. Systemic JIA:
Involves inflammation in one or more joints, along with systemic
symptoms such as high fever, rash, and generalized enlargement of
lymph nodes.
4. Enthesitis-related arthritis:
Inflammation occurs at the sites where tendons and ligaments
attach to bones (entheses).
It is often associated with enthesitis, arthritis, and enthesopathy.

5. Psoriatic arthritis:
Presents with both joint inflammation and skin manifestations,
such as psoriasis or nail changes.
6. Other rare subtypes:
These include juvenile lupus, juvenile dermatomyositis, and
juvenile spondyloarthropathies

SIGN AND SYMPTOMS
• The signs and symptoms of juvenile arthritis vary depending on the
subtype and the individual child. Common features include:
 Joint pain: Persistent pain in one or more joints, which may be
worse in the morning or after periods of rest.
 Joint swelling: Affected joints may appear swollen, warm to the
touch, and tender.
 Joint stiffness: Stiffness and limited range of motion in the
affected joints, especially upon waking up in the morning or after
periods of inactivity.

 Fatigue: Generalized tiredness and lack of energy, which can
affect a child's daily activities.
 Systemic symptoms: Systemic JIA may present with high spiking
fevers, rash, and enlarged lymph nodes.
 Eye inflammation: Certain subtypes of juvenile arthritis, such as
oligoarticular JIA, can be associated with uveitis, an inflammation
of the eye.
• It is important to note that the symptoms may fluctuate in severity,
with periods of flare-ups and remission.

• The diagnosis is typically based on a combination of clinical findings,
medical history, physical examination, and laboratory tests.
• Laboratory tests commonly used in the diagnostic process include:
 Blood tests: such as CBC, ESR, CRP, RF, and ANA testing. These
tests help assess the presence of inflammation and autoimmune
markers.
 Joint fluid analysis:
 Imaging studies: X-rays and other imaging modalities, such as US
and MRI.
Eye examination

TREATMENT
• The management of juvenile arthritis aims to control symptoms,
prevent joint damage, and improve the child's quality of life.
• Treatment plans are individualized based on the subtype, disease
activity, and the child's specific needs.
• A multidisciplinary approach involving rheumatologists, physical
therapists, occupational therapists, and other healthcare professionals
is often necessary.

• Treatment options for juvenile arthritis include:
 Nonsteroidal anti-inflammatory drugs (NSAIDs):
 Disease-modifying antirheumatic drugs (DMARDs):
 Biologic agents:
 Corticosteroids

COMPLICATION
• Without appropriate treatment, juvenile arthritis can lead to significant
complications and long-term disability such as
 Joint damage,
 deformities, and
 growth disturbances are possible outcomes, particularly if the
disease remains uncontrolled.
• Children with systemic JIA may experience complications related to
systemic inflammation, such as pericarditis or macrophage activation
syndrome.

PROGNOSIS
• The prognosis for juvenile arthritis varies depending on the subtype,
disease severity, and the child's response to treatment.
• Early diagnosis and prompt initiation of appropriate therapy are
associated with better outcomes.
• Regular follow-up with a rheumatologist is essential to monitor
disease activity, adjust treatment as needed, and address any
emerging complications.

PHYSIOTHERAPY ASSESSMENT
• Assessment include a thorough examination of
 joint range of motion,
 muscle strength,
 posture, and
 functional abilities.
• It helps the physiotherapist develop an individualized treatment plan
tailored to the child's specific needs

• Aim of physiotherapy management
 to reduce the pain
 to improve joint mobility and ROM
 to improve the muscle strength and balance
 to improve posture and alignment
 to achieve functional independence
 to promotes physical fitness
 patient education

• Physiotherapy management include
 ROM exercises
 Strengthening Exercises
 Heat therapy
 Cold therapy
 Transcutaneous electrical nerve stimulation (TENS)

 Ultrasound therapy
 Assistive Devices
 Functional Training
 Education and Home Exercise Program

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