Healthcare Service Improvement Team
Primary and secondary prevention ofjuvenile idiopathic arthritis
Author:Norma Prosser, Dr Mary Webb, Public Health Specialists
Date:11June 2010 / Version:1
Publication/ Distribution:
- Public (Internet)
Review Date: A review of this document is not planned by Public Health Wales NHS Trust.
Purpose and Summary of Document:
The document has been produced to assist local health boards to implement the Commissioning Directive on Arthritis and Chronic Musculoskeletal Conditions, and should be read in conjunction with that publication.
This is an evidence-based summary of effective interventions for primary and secondary prevention of juvenile idiopathic arthritis.
No effective interventions have been identified from the available evidence.
Work Plan reference: HS02
Date: 11June 2010 / Version:1 / Page: 1 of 7
Public Health Wales / Primary and secondary prevention of juvenile idiopathic arthritis
CONTENTS
1Background
2Juvenile idiopathic arthritis
2.1Introduction
2.2Search methodology
2.3Prevalence
2.4Hospital admissions
3Primary prevention
4Secondary prevention
5Further information
6References
© 2010 Public Health Wales NHS Trust.
Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.
1Background
This document has been produced to assist local health boards to implement the Welsh Assembly Government’s, Designed for people with chronic conditions. Service development and commissioning directives. Arthritis and chronic musculoskeletal conditions1, and should be read in conjunction with that publication.
A key action identified in chapter 2, Prevention – reducing the risks (p.9)of the publication, is evidence-based primary and secondary prevention1. From the key categories identified in the commissioning directive (p.2), the aim in this document is the identification of currently available information and evidence-based literature with a focus on juvenile idiopathic arthritis.
To supplement the evidence–base, and provide an overview of the topic, information with regard to prevalence (where available); hospital admissions (where information is available from Patient Episode Database Wales - PEDW); and links to additional information resources have been included. The links to further information resources is included to indicate where additional details, or management and treatment guidance can be sought.
The information contained in this document is not exhaustive
2Juvenile idiopathic arthritis
2.1Introduction
Inflammatory arthritis conditions cause inflammation in the joints and symptoms can include severe pain, stiffness, fatigue, deformity and reduced joint function. Joints and organs can be affected, and severe inflammatory arthritis can significantly shorten life expectancy.Inflammatory arthritis includes some of the most severe, painful and disabling musculoskeletal conditions, some of which start in children or young adulthood.Conditions include juvenile idiopathic arthritis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis1.
It is not known what causes a person to develop inflammatory arthritis. Various factors may be relevant, including the environment, infection, trauma and a person’s genetic make-up3.
Juvenile idiopathic arthritis (JIA) is an inflammatory arthritis and it is one of the most common causes of physical disability that begins during childhood2.
JIA is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause which begin before 16 years of age3.The cause of the disease is poorly understood but seems to be related to both genetic and environmental factors, which result in the heterogeneity of the illness3.
Why a child develops JIA is not fully understood. It is considered to be an autoimmune disease, possibly genetic3, 4, twin and family studies have provided evidence for genetic contributions to susceptibility of JIA4, other factors are also considered to contribute to setting off a reaction to the immune system3, 5.
2.2Search methodology
Search terms used: primary prevention, secondary prevention, juvenile idiopathic arthritis.
Search terms were kept broad to maximise retrieval of literature and search limits set to retrieve papers published between January 2003 to January 2010.
Electronic databases: Medline; Embase; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials and British Nursing Index.
Meta search engines: Turning Research Into Practice (TRIP); Google Scholar; SUMsearch.
Websites: NHS Evidence; International Network of Agencies for Health Technology Assessment (INAHTA); National Institute for Health and Clinical Excellence (NICE); National
2.3Prevalence
In the UK around 12,000 children under 16 years are affected by JIA6, which equates to 600 children in Wales. It is the most common chronic rheumatic disease in children and is a major cause of short-term and long-term disability4, 5.
2.4Hospital admissions
Figure 1: Number of children and young adults admitted to hospital in Wales 2000-2009 with a principal diagnosis of juvenile arthritis (ICD-10: M08)
Source: PEDW
3Primary prevention
The cause of JIA is unknown and hence primary prevention measures are lacking3.
4Secondary prevention
The cause of JIA is unknown and hence secondary prevention measures are lacking.
5Further information
Arthritis and Musculoskeletal Alliance (ARMA):
- Standards of care for people with inflammatory arthritis.
British Society of Rheumatology Standards of Care for Rheumatoid Arthritis:
- BSPAR standards of care for children and young people with juvenile idiopathic arthritis
of Care.pdf
Map of Medicine
- Juvenile arthritis – one to four joints inflamed;
- Juvenile oligoarthrits – suspected;
- Juvenile oligoarthrits – confirmed;
- Juvenile arthritis – five or more joints inflamed;
- Polyarticular juvenile arthritis – suspected;
- Polyarticular juvenile arthritis – confirmed;
- Systemic juvenile arthritis – suspected;
- Systemic juvenile arthritis – confirmed
NICE
- Etanercept for the treatment of juvenile idiopathic arthritis. TA35. 2002.
- The clinical effectiveness and cost effectiveness of etanercept and infliximab for rheumatoid arthritis and juvenile poly-articular idiopathic arthritis. TA36.2002.
6References
- Welsh Assembly Government. Designed for people with chronic Conditions. Service development and commissioning directives. Arthritis and chronic musculoskeletal conditions.Cardiff: WAG; 2007. Available at: 20th Nov 2009]
- Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369:767
- Arthritis and Musculoskeletal Alliance. Standards of care for people with inflammatory arthritis. London: ARMA; 2004. Available at: [Accessed 20th Nov 2009]
- Takken T et al. Exercise therapy in juvenile idiopathic arthritis. Cochrane Database Syst Rev 2008, Issue 2. Art. No.: CD005954. DOI: 10.1002/14651858.CD005954.pub2. Available at: [Accessed 3rd Dec 2009]
- British Society of Paediatric and Adolescent Rheumatology. Standards of care for children and young people with juvenile idiopathic arthritis.London: BSPAR; 2009. Available at: 3rd Dec 2009]
- Prahalad S, Glass DN. A comprehensive review of the genetics of juvenile idiopathic arthritis. Pediatric Rheumatology 2008, 6-11. Available at: [Accessed 20th Nov 2009]
Date: 11June 2010 / Version:1 / Page: 1 of 7