Chronic arthritis in children and young people

Arthritis affects 1 in 1000 children and young people and is a major cause of potential morbidity, with significant long-term consequences, joint damage and disability if undiagnosed and not treated appropriately. Diagnosing juvenile idiopathic arthritis (JIA) can be challenging and relies on suspicion, careful clinical assessment and judicious interpretation of investigations, which although helpful to exclude other conditions, can be normal in JIA. The clinical 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 pathways, has helped optimize clinical outcomes and dramatically changed how JIA has been managed over the last decades. The approach to management is multidisciplinary, including 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 enabling and empowering young people to transition and transfer to adult rheumatology.