arthritis in children

Overview

Arthritis is a condition where one or more joints become inflamed, causing pain, swelling, stiffness, and warmth. When this happens in children, it is often called juvenile idiopathic arthritis, or JIA. It can affect any child, and the cause is not fully understood, but it is an autoimmune problem where the body's immune system mistakenly attacks its own healthy joint tissue.

Arthritis in children is not very common, but it is not extremely rare either. In the UK, around 1 in 1,000 children is affected.

It can start at any age before 16, including in babies and toddlers. Some types are more common in girls, but boys can get it too.

Symptoms

Common symptoms

• Joint pain that may be worse in the morning or after resting
• Swelling, warmth, or redness around a joint
• Stiffness that lasts for more than 30 minutes after waking up
• Limping, especially in the morning or after naps
• Having trouble using an arm or leg, like avoiding writing, walking, or playing
• Feeling unusually tired or irritable

Symptoms in children

• Young children may not say they hurt; they may just stop using an arm or leg, cry when picked up, or become more clingy or fussy.
• They may refuse to do activities they used to enjoy, like drawing, climbing, or riding a bike.
• Morning stiffness can make it hard to get dressed or walk after waking up.
• Some children have eye inflammation (uveitis) without any noticeable eye symptoms, which is why regular eye checks are important.

Symptoms in older adults

• Arthritis in older adults is most often osteoarthritis, which comes from years of wear and tear on joints.
• It usually affects the knees, hips, hands, and spine, and pain tends to get worse with activity and feel better with rest.
• Older adults may also get gout or other types, but these are not the same as childhood arthritis.

Causes

Main causes

• The exact cause of childhood arthritis is unknown.
• The most common type, juvenile idiopathic arthritis, happens when the immune system attacks the lining of the joints, causing inflammation.
• A combination of genes and some outside trigger, like an infection or stress, may switch the condition on.

Risk factors

• A family history of autoimmune diseases, such as arthritis, lupus, or Crohn’s disease
• Carrying certain genes that make a child more likely to get arthritis (though having the genes does not mean they will definitely develop it)
• Being female for some types of childhood arthritis
• Age — it can happen at any age in childhood, but some forms peak in toddler years or early teens

When to see a doctor

See a doctor urgently if:

• If your child has a red, hot, swollen joint and a high fever, seek urgent medical help — call your local emergency number.
• If your child cannot move a joint or cannot put any weight on a leg after a joint problem, get same-day care.

Book a routine appointment if:

• Make a routine appointment with your doctor if your child has joint pain, stiffness, or limping that lasts for more than two weeks.
• Also see your doctor if you notice any joint swelling that comes and goes, particularly if it’s linked with morning stiffness.

Diagnosis

A doctor will ask about your child’s symptoms, examine their joints, and may order blood tests and imaging. Since there is no single test for arthritis, the diagnosis is based on the full picture. If the doctor thinks it could be arthritis, they will usually refer your child to a specialist called a paediatric rheumatologist.

Tests that may be done

• Blood tests — these can look for markers of inflammation and certain antibodies, but they are not definitive and may be normal.
• Joint ultrasound or X-rays — these help show fluid, swelling, or joint damage.
• Eye examination — because children with some types of arthritis can develop eye inflammation (uveitis) even without symptoms.

What to expect at your appointment

The diagnosis process can take a few weeks or months. You may need to see a specialist team that includes a doctor, nurse specialist, physiotherapist, and occupational therapist. It can be a stressful time, but the team will guide you through the next steps.

Treatment

The goal of treatment is to control inflammation, relieve pain, keep joints moving, and prevent damage so your child can enjoy a normal childhood. Treatment usually involves a mix of medicines, physical therapies, and lifestyle support. There is no cure yet, but many children achieve long-term remission.

Self-care at home

• Encourage regular, gentle exercise like swimming or cycling, which keeps joints moving without too much strain.
• Use warm baths or warm packs to ease morning stiffness, and cool packs to reduce swelling after activity.
• Help your child balance rest with activity, and let them rest if they are tired or having a flare.
• Choose comfortable, supportive footwear that protects the feet and ankles.
• Keep a healthy weight, as extra weight puts more stress on joints.

Medical treatments

Doctors may use medicines to reduce pain and inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs) — but these should only be given as prescribed by your child’s doctor. For more active arthritis, treatment may include medicines that quiet the immune system, called disease-modifying anti-rheumatic drugs (DMARDs), or biologic therapies given as injections or infusions. Sometimes steroid injections are placed directly into a swollen joint to quickly reduce inflammation. Always discuss any treatment with a paediatric rheumatologist, and never give your child any medication without a doctor’s advice.

When is surgery considered?

Surgery is rarely needed for children with arthritis. In very severe cases, a joint may need to be drained, a contracture (tightened tendon) may need releasing, or, in extremely rare cases, a damaged joint may need replacing. These options are only considered when other treatments have not worked.

Living with this condition

Help your child stay active and involved in school and family life. Work with teachers to make small changes, like extra time for moving between classes or comfortable seating. Morning routines can take longer, so start the day a little earlier. Let your child take breaks when they need them, and try to keep a calm and supportive environment.

Lifestyle tips

• Establish a regular sleep routine — good sleep reduces fatigue and helps the immune system stay balanced.
• Encourage open communication so your child can tell you how they’re feeling, both physically and emotionally.
• Celebrate effort and small achievements, not just results.
• Connect with other families of children with arthritis — they understand what you’re going through.

Diet and exercise

There is no special diet that can cure childhood arthritis, but a balanced diet with plenty of fruits, vegetables, whole grains, and healthy fats supports growth and overall health. Exercise is very important: it strengthens muscles, keeps joints flexible, and boosts mood. Work with your child’s medical team to design a safe exercise plan, and let your child choose activities they enjoy.

Mental health and emotional wellbeing

Living with arthritis can be difficult for a child. They might feel frustrated, sad, or as if they’re different from other children. Be patient and listen. It can help to talk to a child psychologist or counsellor who has experience with long-term conditions. School stress can also be an issue, so make sure your child has extra support if needed.

Prevention

Childhood arthritis cannot be prevented because it is an autoimmune condition that is not caused by anything you or your child did. However, early recognition and prompt treatment can prevent joint damage and long-term disability.

Vaccines

There is no vaccine that prevents arthritis, but keeping up with routine childhood vaccines is recommended to help avoid infections that could possibly trigger a flare or complicate treatment.

Screening programmes

There is no routine screening for childhood arthritis. Early medical assessment is the most important step if symptoms appear. Children with arthritis also need regular eye checks to screen for uveitis.

Complications

If left untreated

• Permanent damage to the joints, leading to loss of movement and function
• Uneven growth in arms or legs, or overall growth problems
• Eye inflammation (uveitis), which can affect vision if not monitored
• Long-term disability that affects school, play, and later life

Long-term outlook

The outlook for children with arthritis is much better today than it was in the past. With modern treatment, most children can expect to keep active joints, attend school normally, and go on to live full adult lives. Many children enter remission, meaning their symptoms disappear for months or years. Every child is different, and your child’s rheumatology team will be with you every step of the way.

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