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Early Diagnosis Makes a Difference

The emergence of biologic agents, as well as earlier and more aggressive treatment approach, has dramatically changed the way that JIA has been managed over the last 10 years.

Many children will do very well on treatment and will go into disease remission.

Key to a good clinical outcome is prompt diagnosis and referral to a specialist paediatric rheumatology clinic.

As soon as JIA is suspected, early referral to specialist teams facilitates prompt treatment and prevention of complications including joint damage, contractures, and disability. There has been a trend for several years to minimise exposure to systemic corticosteroids which can have side effects (growth retardation, osteoporosis, weight gain and skin changes (striae and hirsutism), cataracts and adrenal suppression). 

The photographs below demonstrate examples of joint damage before the advent of current treatment approaches; these complications are now uncommon where such treatments are available and children are diagnosed quickly and are managed by specialist centres. 

The photograph below shows a longer left leg, valgus deformity and thigh wasting from untreated chronic arthritis in the left knee. There is also a valgus deformity at the left ankle. This patient progressed to need a left knee replacement and ankle fusion as a young adult. She has extended oligo-articular JIA but had no DMARD or biologic treatment as a child.  

The photograph below shows extensive joint swelling and deformity in the hands and wrists.

The child had polyarticular JIA. 

 The photograph below shows a blind eye with cataract from chronic anterior uveitis. 

 The photograph below shows a short right leg with calf wasting and tip toe posture in polyarticular JIA - the child had severe hip, knee and ankle involvement. 

The photograph below shows osteopenia and vertebral collapse (arrow) from osteoporosis

The photograph below shows severe valgus deformity, muscle wasting and abnormal foot posture from severe systemic JIA with polyarthritis. The child also has severe wrist and finger involvement. 

 The photograph below shows finger contractures, subluxation at the wrists due to chronic, untreated arthritis 

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