Management of the Upper Extremity in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is a chronic heterogeneous condition characterized by inflammatory arthritis persisting for at least 6 weeks in children younger than 16 years without another identifiable cause. Clinical examination is the cornerstone of diagnosis, although various imaging modalities may be used to establish clinically inconspicuous disease, identify structural damage, and monitor treatment response. Serologic testing is primarily used to categorize JIA subtype and provide prognostic information on the disease course. Early diagnosis and treatment initiation are important to preserve functionality, facilitate expected skeletal growth potential, and mitigate long-term articular damage. Treatment can involve physical and occupational therapies, systemic medication, intra-articular corticosteroid injections, and surgical intervention. Disease-modifying antirheumatic drugs have been shown to be effective and safe in children, with remission rates of more than 50% within 1 year of treatment initiation. JIA typically follows a lifelong relapsing course. It is ideal to avoid surgical intervention until a child reaches skeletal maturity to prevent physeal damage. However, surgery can be important to mitigate lifelong articular and soft-tissue damage and to optimize pain management and functionality. Overall, there is a paucity of literature regarding long-term outcomes in the surgical management of JIA. This article will review the current literature on the pathophysiology, diagnosis, and management of JIA of the upper extremity.