Skip to main content
What types of page to search?

Popular pages: Undergraduate Postgraduate PhD Accommodation Research International students

Alternatively use our A-Z index.

Juvenile Idiopathic Arthritis (JIA)

JIA is a condition characterised by inflammation of one or more joints for which there is no known cause.

Juvenile Idiopathic Arthritis (JIA)

JIA is a condition characterised by inflammation of one or more joints for which there is no known cause.

Several types of arthritis fall under the term JIA, which all present under the age of 16 years. It is a chronic disease, and around half of children will continue to suffer from arthritis as adults. There are approximately 12,000 children (1 in 1000) in the UK under 16 years of age who have JIA, with 1 in 10,000 children diagnosed each year.

There are many treatments for JIA, including anti-inflammatory drugs, disease-modifying drugs, and biologics. However, not all children respond to these drugs in the same way, and some may develop side effects. Therefore, it is crucial to continue looking for new treatments. 

EATC4Children led a national HTA-funded study of ‘Steroid Induction Regime in JIA (SIR-JIA); HTA14/167/0 (CI: E. Baildam). This feasibility study identified the need to conduct a future randomised controlled trial to assess steroid treatment regimens in JIA.

As a result of this feasibility study, the STAR-JIA trial was developed in line with the patient priorities that were identified. Co-Chief Investigators Clare Pain, and A V Ramanan, lead the STAR-JIA trial. STAR-JIA is a multi-site, randomised controlled trial. The overall aim of this trial is to compare the effectiveness, safety and cost-effectiveness of intravenous versus oral corticosteroid treatment for children and young people with new onset polyarticular JIA.

The trial is funded by the National Institute for Health Research's Health Technology Assessment Programme (NIHR HTA) and is sponsored by Alder Hey Hospital. The day-to-day running of the trial, monitoring and analysis is being coordinated by a team at the Liverpool Clinical Trials Centre (LCTC).

Find more information, and the trial animation, on their website. 

Early phase JIA clinical trials that the EATC4Children are involved in include:

Juvenile Idiopathic Arthritis / Uveitis workstreams

STAR-JIA associated Biobank: Through unanimous support from our lay applicants in STAR-JIA, we have embedded a biobank within the trial to link robust trial outcomes to molecular phenotypes. The trial is open, and patients are being recruited. This underpins future work including pharmacogenomics of corticosteroid response which would allow us to stratify corticosteroid regimens to patients to improve response and minimise corticosteroid toxicity.

Psoriasis-associated Arthritis

We continue to investigate the identification of differential molecular pathomechanisms between skin psoriasis, psoriatic arthritis/JIA, and other forms of seronegative inflammatory arthritis (SIA). Having previously identified DNA methylation signatures in CD4+ and in CD8+ T cells that separate skin psoriasis from psoriatic arthritis patients while reflecting skin disease activity and a panel of RNAs differentially expressed in psoriasis versus atopic dermatitis patients in CD4+ and CD8+ T cells, we have further investigated whether these gene expression signatures characterise patient groups in peripheral blood samples, and whether they differ between skin psoriasis and psoriatic arthritis. Gene expression and epigenetic signatures may be used to predict the development of arthritis and may be used within future clinical trials as a molecular surrogate for skin inflammation.

We used state-of-the-art spatial transcriptomics approaches to identify transcriptional differences in small immune cell subsets in the skin of patients with psoriasis or atopic dermatitis to predict biomarker candidates that we then validated in peripheral blood samples from further patients.
This successful approach promises large potential for future studies to identify therapeutic targets in T cell mediated inflammatory skin diseases.

In previous pilot experiments (GHOST Project), we detected bacterial extracellular vesicles (BEVs) in the synovial fluids of patients with different forms of JIA. This study is now underway with a goal of identifying microbiota signatures associated with JIA subtypes. This may allow for microbiota engineering approaches in the future treatment and prevention of JIA (and other inflammatory diseases).

Virtually the same, but remotely different: Understanding Experiences of Remote Out-patient Consultations in Paediatric Rheumatology

The REFLECT study explored how remote healthcare appointments—via phone or video— were experienced by health professionals, parents, and children with juvenile idiopathic arthritis (JIA). This study brought together researchers from Alder Hey, Conducted in a paediatric rheumatology clinic in Alder Hey Children’s Hospital, the research reveals that while remote consultations offer convenience, they also introduce new dynamics in communication, trust, and clinical assessment.

Key Themes

  • Catch-up vs. Check-up – Remote sessions often feel less thorough than face-to-face ones
  • Shift in Roles – Families take more responsibility in reporting symptoms and sharing information
  • Minimised Disruption – Families appreciate reduced travel and time off work/school
  • Being Seen Differently – Lack of physical presence changes how patients are perceived and how they interact.

Practical Resources from the Study

  • Animation: tips for all ages on how to prepare for a remote consultation 
  • Children’s Guide: A simple, illustrated leaflet for children on what to expect in a phone or video appointment
  • Young People's Guide: Tips for teenagers on how to prepare, where to take the call, and how to advocate for themselves
  • Health Professionals’ Guide: Evidence-based advice for clinicians on improving virtual care interactions.

These tools, co-created with children, families, and clinicians, offer actionable guidance to ensure remote appointments are effective, respectful, and inclusive.

We have requested endorsement for these resources from Royal College Paediatrics and Child Health and Royal College of Nursing.