Rob Volansky , 2025-05-08 09:30:00
DESTIN, Fla. — Understanding the subtypes of juvenile idiopathic arthritis can help adult and pediatric rheumatologists manage patients appropriately, according to a speaker at the Congress of Clinical Rheumatology East annual meeting.
“We built this slide deck to remind people what childhood rheumatologic diseases are like,” John M. Bridges, MD, MS, assistant professor in the division of pediatric rheumatology at the University of Alabama at Birmingham, told attendees. “Just as it is important to understand the different flavors of adult inflammatory arthritis, it is also important to understand the different subtypes of JIA.”
Drawing parallels
The first subtype Bridges discussed was rheumatoid factor (RF)-positive polyarticular JIA. He described this condition as “RA junior.” This inflammatory arthritis can impact large and small joints, as well as involve joint contractures and rheumatoid nodules.
Similarly, psoriatic JIA has many similarities to adult psoriatic arthritis.
“This is PsA junior,” Bridges said.
Psoriatic JIA can involve nail pits and dactylitis. Distal interphalangeal joint involvement is common, as are erosions.
According to Bridges, enthesitis-related arthritis can be compared with spondyloarthropathies in adults. These patients often have HLA-B27 positivity and erosions in the sacroiliac joint.
Meanwhile, RF-negative polyarticular JIA is similar to seronegative RA.
“This is another way to lump these things together, as in the adult spectrum,” Bridges said.
This condition is often symmetric and can be found in large and small joints, he added.
Systemic JIA, or Still’s disease, can be seen in parallel with adult-onset Still’s disease.
“This is the more autoinflammatory arthritis in childhood,” Bridges said.
Macrophage activation syndrome and interstitial lung disease are concerns in this patient population, he added.
The last juvenile subtype that mirrors a condition among older patients is undifferentiated JIA, which has parallels with undifferentiated inflammatory arthritis in adults.
According to Bridges, oligoarticular JIA is unique among the JIA subtypes in that it is solely a pediatric disease.
“There is no adult counterpart for this disease,” he said, adding there is no blood test available to diagnose this condition. “This is a clinically diagnosed disease.”
Digesting the ‘alphabet soup’
Bridges stressed that adult rheumatologists confronted with new patients coming from pediatric care should familiarize themselves with each of these subtypes.
“I hope walking through this alphabet soup you might see on the charts for these patients lets you know that subtypes do matter,” he said. “It is important to drill down which subtype they are diagnosed with.”
Regarding specific complications of pediatric patients with arthritis, Bridges highlighted uveitis as a primary concern.
Unfortunately, this comorbidity often goes undetected until vision loss occurs.
“Younger onset of disease puts you at higher risk,” Bridges said. “It is most common in oligoarticular JIA.”
Another unique complication of JIA or inflammatory arthritis in children can be found in the temporomandibular joint (TMJ), according to Bridges.
“It is hard to diagnose,” he said. “Having TMJ pain does not correlate to having TMJ arthritis.”
A final consideration for pediatric patients with arthritis is leg length discrepancy. Bridges urged attendees to pay attention to the hips and lower back pain of these patients.
‘More aggressive’ treatment
Treatment approaches can also vary between children and adults.
“We tend to be more aggressive with our treatment of inflammatory arthritis in pediatric patients,” Bridges said. “Kids metabolize medications differently.”
This aggression is often warranted because childhood-onset disease demonstrates high morbidity and mortality, according to Bridges.
Finally, Bridges encouraged adult rheumatologists to be sensitive to the needs of pediatric and adolescent patients transitioning to adult care.
“This is a complicated time of life,” he said, noting that changes in peers, geography, friendships and family relationships are common.
Bridges suggested that pediatric rheumatologists can be a great resource for managing these challenges.
“We love to talk about our patients,” he said. “We would love to help you care for that patient better.”
Sources/Disclosures
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Bridges JM. Best Management of Patients Diagnosed With a Pediatric Rheumatologic Disease: A Med-Peds Rheumatologist’s Insights into Caring for Adult Patients with JIA and Childhood-Onset SLE. Presented at The Congress of Clinical Rheumatology East; May 1-4, 2025; Destin, Florida (hybrid meeting).
Disclosures:
Bridges reports no relevant financial disclosures.
