Services in Wales
If your child has had symptoms of painful, stiff or swollen joints, which have persisted for a few weeks and you have taken them to your GP, they may be referred to a paediatric rheumatologist if they suspect your child has arthritis. However, because arthritis in children is relatively rare and many GPs have not seen a child with arthritis before and are not used to assessing for it, they may first of all refer your child to a consultant paediatrician, an adult rheumatologist or consultant orthopaedic surgeon who have experience of looking after children with joint inflammation.
To be able to make a diagnosis of JIA, when your child attends the children’s rheumatology clinic for the first time they will be referred for (see flowchart below):
- blood tests to help decide what kind of arthritis they have and to check their immunity to some infections
- X-rays or scans of their joints to see if there is any damage or narrowing of the joint space because of inflammation
- eye tests to check for inflammation in their eyes
They will also been seen by the rheumatology nurse specialist who will give you information on JIA and explain to you what all the different tests are for and what the different treatments are. Your child may also receive a joint injection or other types of drug treatments to treat any inflammation (link to flowchart) and may also be referred for:
At the end of this appointment your child will receive a follow-up appointment so the consultant can assess how your child’s arthritis has responded to any treatments they may have had and to discuss what happens next. Once a diagnosis of JIA has been confirmed, your child should have appointments with their consultant approximately every three months to see if your child is getting better, to make sure they are on the correct medication (if needed) and discuss any problems. If your child has started medication they may need blood tests to check it is not having any side effects.
If they have any problems however, before their next appointment you can contact the children’s rheumatology nurse specialist.
Children living in Wales who have JIA are often looked after in specialist outreach clinics locally to where they live. Children living in the Bangor and Wrexham areas are seen by the children’s rheumatology specialists from Alder Hey Children’s Hospital in Liverpool. Those living in the Carmarthenshire, Ceredigion, Pembrokeshire and parts of Powys and Gwynedd are seen by specialists at Aberystwyth whilst others from mid Wales will be seen at Birmingham Childrens’ Hospital. Children and young people from South and West Wales will be seen by the specialist children’s rheumatology team at the Children’s Hospital for Wales in Cardiff. There is also an outreach clinic at the Royal Glamorgan Hospital in Llantrisant run from Cardiff and an outreach clinic in Swansea run from Bristol (link map).
Referral pathway in the diagnosis of JIA - Wales