Juvenile idiopathic arthritis is a collection of arthritic conditions that develop in children and adolescents. It is imperative to diagnose juvenile idiopathic arthritis as quickly as possible, as aggressive treatments need to be initiated early in the disease course in order to prevent or slow down joint damage and maintain as much function and mobility as possible.
If your child is displaying symptoms associated with juvenile idiopathic arthritis, then your family doctor will likely refer you to a rheumatologist. The early symptoms associated with juvenile idiopathic arthritis are:
- Joint swelling and stiffness
- Joint pain in the hands, wrists and knees
- Skin rashes
- Enlarged lymph nodes
- Limping due to stiffness of joints
- Loss of motor function
- Dry eyes
- Inflammation of the eye
A child will likely not display all of these symptoms all at once. If your child displays some of these symptoms, then the rheumatologist will inquire further about the symptoms, such as when they started and how severe they are. The rheumatologist will ask about your child’s personal and your family medical history, as arthritis runs in families. Then, the rheumatologist will likely conduct a physical examination to look for external signs of inflammation and test his or her range of motion.
Unfortunately, there is no one single test that can help diagnose juvenile idiopathic arthritis. However, there are nine different tests that the rheumatologist can order in order to confirm a diagnosis of arthritis and to exclude other conditions:
- Erythrocyte sedimentation rate (ESR). This is a type of blood test that helps determine the level of inflammation in your body. The sedimentation rate refers to the rate at which red blood cells settle down at the bottom of a test tube. This test is often used to diagnose autoimmune conditions such as arthritis. However, the condition is not specific for arthritis and is associated with the development of several different diseases.
- C-reactive protein levels. This is another type of blood test, which looks for levels of a protein known as C-reactive protein. Similar to the ESR, levels of C-reactive protein are also indicative of the level of inflammation in the body as higher levels of C-reactive protein are associated with more inflammation. However, unlike the ESR, this type of test measures inflammation on a different scale. This test is not specific for juvenile idiopathic arthritis, but can help confirm or provide more evidence for the diagnosis.
- Anti-nuclear antibody. This is a blood test that looks for levels of a type of protein known as an anti-nuclear antibody. Similar to the other tests, this is a general test to see whether the patient has an autoimmune disease as several autoimmune conditions are characterized by high levels of anti-nuclear antibody. Additionally, higher levels of anti-nuclear antibody are also characterized by a higher risk of developing eye inflammation.
- Rheumatoid factor. This is another blood test that looks for levels of an antibody known as a rheumatoid factor. Rheumatoid factor is the antibody that is responsible for several symptoms associated with rheumatoid arthritis. Patients with juvenile idiopathic arthritis sometimes have high levels of this antibody. However, a positive or a negative test does not necessarily mean that a patient does or does not have arthritis.
- Cyclic citrullinated peptide (CCP). Doctors can also order a blood test to look for cyclic citrullinated peptide, which is a type of antibody that is often found in patient with juvenile idiopathic arthritis.
- Complete blood count. This a blood test that evaluates levels of different types of blood cells, including red blood cells and white blood cells. Patients with arthritis often develop anemia, which is a deficiency in red blood cells.
- Genetic test. Arthritis often runs in families and scientists have found several different genes that are associated with the development of this disease. In particular, people with a gene known as HLA-B27 are much more likely to develop arthritis compared to people without the gene. Therefore, a doctor may order a genetic test to look for the presence of HLA-B27 as that can help confirm a suspicion of juvenile idiopathic arthritis.
- X-rays. This is a type of imaging test that can help visualize the joint that is affected. This type of test is often conducted to exclude pain or swelling from other diseases, such as fractures, tumors and other defects. This type of imaging can also help visualize the severity of the damage and whether further treatments, such as surgery, will be needed. X-rays can also be used throughout the disease course to monitor progression and damage.
- Magnetic resonance imaging (MRI), which is similar to X-ray but provides more detailed imaging.
If you or your child are unsure why you have to do a specific test, then it is important to ask the rheumatologist and they will provide an explanation. It is very important to diagnose the disease early on so that treatment can be initiated as soon as possible. With proper treatment, your child can live a healthy and full life. Fortunately, most children with juvenile idiopathic arthritis outgrow the disease by the time they are adults.