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Inflammatory arthritis in children

Juvenile idiopathic arthritis is the most common inflammatory and musculoskeletal disorder in children, affecting about 1 in every 1000 children in the UK.

Overview:

Juvenile idiopathic arthritis is the most common inflammatory and MSK disorder in children.

Symptoms of juvenile idiopathic arthritis (JIA) are highly variable, but can cause joint damage leading to severe joint pain and loss of function, inflammation in the eye, growth and development abnormalities, identity and body image crises and lower levels of engagement in social activities. Up to one third of individuals with JIA do not achieve remission, with the disease carrying on into adulthood. . We know that genetic, environmental and psychological factors all play a role however relationships between these influences are still unclear. The high risk of significant lifelong impairment following a diagnosis of JIA is a major driver of this research.

Issue:

Research into the causes and consequences of childhood onset arthritis lags significantly behind that of other musculoskeletal conditions. The lack of research is partly due to the fact that JIA is a relatively rare disease but the situation is complicated by the fact that long-term outcomes and responses to treatment are highly variable. The uncertainty in diagnosis and long-term prognosis is one of the major concerns expressed by patients with JIA and their families.

Currently there are very few appropriate assessment measures designed specifically for use by children, young people and their families. This is a further barrier to undertaking high quality research into causal mechanisms, effective interventions and clinical practices. 

What we aim to achieve:

Our overall goal is to maximise treatment response in order to improve the long-term outcome for the children with arthritis. To address this we will undertake a number of interrelated research projects.

  1. We will develop and evaluate a prognosis-based classification that will form the basis for a more targeted approach to therapy and to a reduction in the occurrence of unnecessary toxic side effects and hospitals visits.
  2. Pain is one of the key symptoms of JIA, surprisingly there is no good method of measuring pain in children with JIA therefore we plan to develop an age-appropriate means of evaluating pain.
  3. There is also evidence to suggest that patients’ understanding of and beliefs about their condition also influences outcomes.  We plan to develop a new measure of illness beliefs suitable for children across the full age range and utilise these to investigate the influence of illness beliefs in children with JIA .

Development of age appropriate patient reported outcome measures (PROMS) and a greater understanding of the relationships between clinical, environmental, genetic and psychological aspects of JIA will help clinicians better understand children’s needs leading to improved care from a patients’ as well as a clinicians perspective.

The combination of these approaches will lead to better long-term outcomes for children with JIA whilst maximising effective use of healthcare resources.

You can view a video of BRU researcher, Dr Suzanne Verstappen, discussing Methotrexate and the Childhood Arthritis Prospective Study with Andrew Ostor on the Rheumatology Congress website.

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