Childhood arthritis: Symptoms every parent, caregiver must never ignore

For many parents, a child waking up stiff, limping to the bathroom or avoiding play might easily be dismissed as a passing phase or a sports injury.

After all, joint pain is often associated with ageing and rarely expected in children. Yet paediatric specialists say arthritis in childhood is real, and its effects can be long-lasting if not recognised early.

Childhood arthritis, commonly known as Juvenile Idiopathic Arthritis (JIA), is a chronic inflammatory condition that affects the joints of children and adolescents. According to Dr Angela Migowa, a Consultant Paediatric Rheumatologist at Aga Khan University Hospital, Nairobi and an Assistant Professor in the Department of Paediatrics and Child Health at Aga Khan University Medical College, East Africa, awareness and early detection are vital.

“When somebody develops a painful, swollen joint, it can come about because of many reasons. Some of it could be infections or even malnutrition, but when the inflammation persists, that’s when we start suspecting arthritis,” she says.

JIA is not a single disease but a group of disorders that share the common feature of joint inflammation lasting at least six weeks. Dr Migowa explains that the most common forms seen in children include systemic arthritis, which affects the whole body and can cause fever and rashes; oligoarticular arthritis, which involves four or fewer joints, often the knees or ankles; and polyarticular arthritis, which affects five or more joints and may resemble adult rheumatoid arthritis.

Specialists also recognise other forms such as enthesitis-related and psoriatic arthritis, though these are less frequently reported. “Each type behaves differently,” Dr Migowa says. “Some are mild and may go into remission, while others can be severe and affect growth or internal organs.”

Because a child’s skeleton is still growing, inflammation can do more than hurt a joint. It can disrupt bone growth and overall development. “In children, the skeleton is still growing. Failure to manage arthritis early means that this child is at risk of lifelong disability,” Dr Migowa cautions.

While adult arthritis often develops from wear and tear, childhood arthritis is largely immune-mediated. The immune system mistakenly attacks healthy joint tissue, leading to inflammation that can damage cartilage, bone and growth plates, the parts responsible for height and limb development. “This is what makes childhood arthritis unique,” Dr Migowa explains. “The joints are still developing. If inflammation isn’t controlled early, the child’s growth can be permanently affected.”

The causes of childhood arthritis are not fully understood but are best described as a mix of genetic predisposition and environmental triggers. “You have a genetic risk in the background of an environmental trigger,” Dr Migowa notes. “This trigger can be diet, infection or stress.”

Family history of autoimmune disease increases the likelihood, and conditions such as psoriasis, celiac disease or inflammatory bowel disease in relatives can point to higher susceptibility. Poor sleep, inadequate nutrition and infections such as influenza or typhoid can also act as triggers.

Globally, studies estimate incidence between 1.6 and 23 children per 100,000 each year, and prevalence varies widely by region. In Kenya, national data show that rheumatic conditions, including childhood arthritis, account for about 0.3 per cent of inpatient admissions and 0.5 per cent of outpatient visits among children.

The World Health Organization and UNICEF have both called for greater awareness of paediatric musculoskeletal diseases, which often go underdiagnosed in low- and middle-income countries.

Spotting the signs early saves function. The most important red flags are persistent joint pain, swelling and loss of function. “A painful joint, a swollen joint, a joint that has lost its function, those are key signs,” Dr Migowa says.

Simple changes such as a child struggling to carry a school bag, play or swim should raise concern. Morning stiffness, fever, fatigue and skin rashes can also accompany the disease. Eye inflammation is another recognised complication that can cause vision problems if missed, and some children experience systemic flare-ups marked by fever and malaise.

Diagnosis relies on careful clinical assessment rather than a single test. “Arthritis is a clinical diagnosis,” Dr Migowa says. A detailed history and physical examination guide further testing to exclude infections and other causes. Misdiagnosis is common. “Most of them have been mismanaged,” she adds. “Some are put on tuberculosis or cancer treatment for months before we see them.” Early referral to a paediatric rheumatologist therefore becomes essential.

Treatment takes a multidisciplinary approach. The goals are to relieve pain, reduce inflammation, protect joints from damage and preserve function. Dr Migowa outlines a plan that combines medication with rehabilitation. “We use physiotherapy, occupational therapy, nutrition therapy and psychotherapy alongside medication,” she says.

Medications include non-steroidal anti-inflammatory drugs to ease pain, corticosteroid injections to reduce inflammation, and disease-modifying antirheumatic drugs (DMARDs) or biological agents that control the immune response. All require close monitoring because of possible side effects such as lowered immunity or effects on the liver, kidney and blood counts.

Complications can be severe if the disease is untreated or poorly managed. Joint deformities, unequal limb growth, chronic pain and disability are among long-term consequences. Additional problems include eye inflammation, growth failure and the psychological toll of living with a chronic illness. Children often experience anxiety or depression, which underscores the need for family and school support.

While complete prevention of childhood arthritis is not possible, adopting healthy routines can help reduce triggers and improve outcomes. Good nutrition, adequate sleep, infection control and stress reduction all play a role.

Regular physical activity tailored to a child’s capacity and prompt medical review for persistent joint symptoms are also key.

The hopeful message is that modern medicine has transformed outcomes for many children living with arthritis. With early diagnosis and sustained multidisciplinary care, most can achieve remission and lead full, active lives. “We may not always achieve a cure,” Dr Migowa reflects, “but we can achieve remission and maintain it so that your gains are not destroyed.”

The key message for families, teachers and healthcare providers is clear: do not dismiss a child’s joint pain.

Early recognition, timely referral and comprehensive care can protect a child’s development and preserve their future.