Early Detection Crucial In Managing Juvenile Idiopathic Arthritis

By Alyaa Natasha Azhar

KUALA LUMPUR, Oct 14 (Bernama) -- Early detection and immediate medical intervention remain paramount in managing Juvenile Idiopathic Arthritis (JIA), an autoimmune condition that can affect children as young as eight months old, a medical expert said.

However, low public awareness of the condition often results in delayed diagnosis, potentially leading to irreversible joint damage in affected children, according to Sunway Medical Centre, Sunway City's (SMC) paediatric rheumatologist Dr Cham Weng Tarng.

“JIA is an autoimmune condition that affects children below the age of 16. The youngest patient we have seen was in late infancy, and the disease can affect any joint in the body,” he told Bernama in an interview at SMC.

Dr Cham said a diagnosis of JIA requires persistent joint inflammation for at least six weeks, after other possible causes, such as localised infections and malignancies, have been ruled out.

He said JIA is classified into seven subtypes - systemic arthritis, oligoarthritis, rheumatoid factor-negative polyarthritis, rheumatoid factor-positive polyarthritis, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis -  which can affect one or more than four joints.

Dr Cham said detecting JIA in infants and toddlers posed a particular challenge as young children were often unable to articulate their physical discomfort.

“Younger children are sometimes unable to express that they are in pain, so parents usually notice it from the way their child moves, like walking with a limp or  refusing to walk,” he said.

He said symptoms could be subtle, recounting a case in which an infant’s hip arthritis was detected after the child repeatedly cried in distress whenever the nappy was changed.

For older, active children who frequently fall or sustain sports-related injuries, Dr Cham advised parents to seek medical evaluation if joint pain or swelling persisted for more than a week.

He said parents should not dismiss such symptoms as ordinary childhood injuries, as persistent pain or swelling could indicate an underlying condition requiring medical attention.

Dr Cham said a major challenge in managing JIA was the misconception among some parents that their children were exaggerating their symptoms or being difficult, which could delay diagnosis and critical treatment.

He highlighted the case of a patient who became wheelchair-bound at the age of 11 after discontinuing medical treatment for five years, allowing the condition to deteriorate severely.

Once the joints are damaged by arthritis, we cannot reverse it. So, what we try to do is maintain function and mobility,” he said.

Dr Cham said the delayed intervention had led to severe joint deterioration and left the child’s bones extremely fragile, increasing the risk of fractures even from falls.

Beyond joint destruction, Dr Cham warned that children with JIA were also at risk of developing uveitis, an inflammatory eye condition that requires regular monitoring and management by an ophthalmologist.

Despite the debilitating risks of late-stage JIA, Dr Cham emphasised that the medical landscape for the disease has undergone a massive technological revolution offering a highly optimistic outlook for all diagnosed patients.

“Previously, in the 1950s, the only medications we could give children were painkillers and steroids. But now, there are many more latest medications such as, disease-modifying anti-rheumatic drugs,” he said.

These include conventional anti-rheumatic medications alongside biological therapies that utilise advanced antibodies to ‘switch off’ internal inflammation without relying solely on steroids.

With controlled and early treatment, Dr Cham assured that children with JIA can achieve sustained improvements, allowing them to lead unrestricted lives.

Dr Cham advised parents of children with newly diagnosed JIA to place their trust in modern medical science, maintain strict adherence to prescribed medication regimes and foster open communication with their treating physicians.

He added that medical facilities with dedicated children emergency department may also be able to provide point-of-care investigations together with on-site dispensing pharmacy to support coordinated paediatric care including for JIA cases.

"Treatment of JIA now is more advanced and there are opportunities for recovery. There is a light at the end of the tunnel. So, there is hope. The most important thing is to seek for treatment as soon as they noticed the early signs,” he said.

--BERNAMA