Other Related Medical Complications Podiatry Foot problems are prevalent in patients with JIA

Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated morbidity, and life-long disability and risk for emotional and social dysfunction. In this article we will review the burden of juvenile arthritis for the patient and society and focus on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on HRQOL; emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes, and sexuality. The extent of impact on the various aspects of the patients', families' and society's functioning is clear from the existing literature. Juvenile arthritis imposes a significant burden on different spheres of the patients', caregivers' and family's life. In addition, it imposes a societal burden of significant health care costs and utilization. Juvenile arthritis affects health-related quality of life, physical function and visual outcome of children and impacts functioning in school and home. Effective, well-designed and appropriately tailored interventions are required to improve transitioning to adult care, encourage future vocation/occupation, enhance school function and minimize burden on costs. Introduction Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease causing erosive arthritis in children, often progressing to disability. JIA occurs in children of all races, with annual incidence ranging from 0.008-0.226 per 1000 children, and prevalence from 0.07-4.01 per 1000 children [1]. A 2007 Centers for Disease Control (CDC) study estimates that 294,000 U.S. children under age 18 (or 1 in 250 children) have been diagnosed with arthritis or another rheumatologic condition [2]. The national direct costs in 1989 are estimated at $285 million in the US for children with arthritis [3]. One of the most frequently occurring pediatric rheumatic diseases, JIA, impacts bio-psychosocial aspects of patients and families necessitating careful diagnosis and initiation of appropriate treatment. JIA is comprised of the following seven categories as per the ILAR (International League of Associations of Rheumatology) classification [4]:1) Oligoarticular onset JIA also termed as Pauciarticular onset JIA (PaJIA); 2) Polyarticular onset JIA (PoJIA RF+) with positive results on testing for Rheumatoid Factor (RF); 3) Polyarticular onset JIA (PoJIA RF-) with negative results on testing for RF; 4) Systemic arthritis (SoJIA); 5) Psoriatic arthritis JIA; 6) Enthesitis-related arthritis; and 7) Other arthritis undefined by above mentioned criteria [4]. Each subtype is associated with specific complications and disabilities. Early disease recognition and institution of appropriate therapy is critical to improve the clinical outcome. As children who have JIA reach adulthood, they face possible continuing disease activity, medication-associated morbidity, life-long disability and risk for emotional and social dysfunction. Children with JIA with uveitis experience additional visual problems leading to disability. In this article we will review the burden of JIA for the patient and society focusing on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on health-related quality of life (HRQOL); emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes; and sexuality. We will discuss the above topics under the three following headings: Physical Disability, Impact on HRQOL and * Correspondence: moorthln@umdnj.edu 1 Robert Wood Johnson Medical School-UMDNJ, Dept. of Pediatrics Room 1361, 89 French Street, New Brunswick, NJ, USA Full list of author information is available at the end of the article © 2010 Moorthy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Moorthy et al. Pediatric Rheumatology 2010, 8:20 http://www.ped-rheum.com/content/8/1/20 Page 2 of 9 Economic burden. Articles related to the above topics in the context of childhood arthritis were selected using MEDLINE search technique. JIA comprises a heterogeneous group of diseases with distinct subtypes and all these subtypes have different phenotypes, course and prognoses. Although, we have included all the subtypes of JIA, we stress here that we need further studies in the following areas in each of the subtype. Further, not all the articles have exclusively used the ILAR system of classification. We have several studies on children with juvenile rheumatoid arthritis (JRA) cited throughout the manuscript.