Chronic arthritis in children and young people

Arthritis affects 1 in 1000 children and young people (CYP) and is a major cause of potential morbidity, with significant long-term consequences, joint damage and disability if left untreated. Diagnosing juvenile idiopathic arthritis (JIA) can be challenging, and relies on clinical assessment. Investigations are helpful to exclude other conditions, but are often normal in JIA at presentation. The history can be vague, and the child may be too young to verbalize symptoms; detailed probing for inflammatory symptoms and a comprehensive examination of the child's joints are therefore essential. If JIA is suspected, early referral to specialist teams facilitates prompt treatment and prevention of complications. The emergence of novel and biologic agents, as well as earlier and more aggressive treatment, has helped to optimize clinical outcomes and dramatically changed the way that JIA has been managed over the last 15 years. The approach to management is multidisciplinary, and includes close liaison with other specialists and primary healthcare teams, as well as education and support for the family. Adolescence is a time of physical, psychological and emotional change, and the multidisciplinary team is fundamental to helping adolescents cope with the implications of a chronic disease, often complex treatment regimens and transitional care into the adult world.