What Happens

The course of juvenile idiopathic arthritis (JIA) is unpredictable, especially during the first few years after a child is diagnosed. JIA, also called juvenile rheumatoid arthritis (JRA) or juvenile chronic arthritis (JCA), can be mild, causing few problems. Symptoms can get worse or disappear without clear reason. Eventually the pattern of symptoms becomes more predictable. In general, children with JIA have one or a combination of symptoms including joint pain, joint swelling, and joint stiffness early in the course of the disease. Many children experience sleep disturbances, including difficulty falling asleep and frequent night awakenings.² Most children have good and bad days.

Of all children who have JIA, 3 or 4 out of 10 children will have long-term disability.³ While the overall long-term outlook for children with JIA is often good, symptoms of the disease can continue into adulthood. Long-term disability may range from occasional stiffness, the need for pain medicine, and limits on physical activity to ongoing arthritis and the need for major surgery such as joint replacement. But for most adults who had JIA as children, any long-term problems tend to be mild and do not affect their overall quality of life. For instance, they may not be able to play certain sports, but their activities are not otherwise limited.

A child's long-term outlook is influenced by the type of juvenile idiopathic arthritis he or she has. While a child with oligoarticular JIA (4 or fewer joints affected) has a good long-term outlook other than eye disease risk, a child with polyarticular JIA (5 or more joints) or systemic JIA (whole-body symptoms) is likely to have more long-term problems.⁴

Treatment also affects the child's long-term outlook. Treatment is usually started as soon as the child is diagnosed, because if treatment can control the inflammation, there is less long-term disability and the tissues may heal over time.⁴

Oligoarticular JIA (oligoarthritis)

Up to 60% of all children affected by JIA have the oligoarticular form.⁴ Some children with more severe disease have joint damage that shows on X-rays within 5 years. Children with oligoarticular JIA (oligoarthritis, meaning "few joints") may continue to have disease as an adult. This risk is higher if more joints are affected after the first 6 months (extended). Among children with oligoarticular JIA:⁴

• Most children continue to have 4 or fewer joints affected. This is called persistent oligoarthritis.
• Fewer than half go on to have 5 or more joints affected after the first 6 months of the disease. This is called extended oligoarthritis, resembling polyarthritis).
• There is an increased risk of having vision loss caused by inflammatory eye disease.
• Some children have uneven leg bone growth, resulting in legs of different length and muscle wasting.³