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Early diagnosis and treatment make a difference

The emergence of biologic agents, as well as earlier and more aggressive treatment approaches, 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. 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). 

As soon as JIA is suspected, early referral to specialist teams facilitates prompt treatment and prevention of complications including joint damage, contractures, and disability. 

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. In many parts of the world, where access to medicines is limited by cost or availability then such presentations and clinical features are still commonly observed.  

The photograph below show leg length discrepancy and leg alignment abnormality in suboptimally treated chronic JIA. The photograph on the left 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. The photograph on the right shows valgus deformity at both knees, worse on the right, muscle wasting (of the calves and thighs) and deformity at the ankles. 

 

The photographs below show extensive joint swelling and deformity in the hands and wrists in polyarticular JIA. 

 

The photograph below shows a blind eye with cataract from JIA related 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 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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