Juvenile idiopathic arthritis (JIA) is defined as unexplained joint swelling that persists for more than 6 weeks under the age of 16 years. The term “idiopathic” means that the cause is not clear. It is one of the rheumatic diseases with a high incidence in children, with a reported incidence of about 9.2 to 23.6 per 100,000 people at home and abroad. It is a chronic disease, after regular treatment, the symptoms of the disease can be relieved and the laboratory indicators can be normalized, but how long it takes to stop the medication should vary according to different subtypes and the severity of the disease. Some subtypes, even if multiple drugs are used in combination, will still be repeatedly delayed, symptoms and laboratory indicators are difficult to control, and can continue into adulthood, eventually developing into joint deformity, affecting joint function, and in severe cases, leading to deformity, disability and bedridden. According to the 2006 National Sample Survey of Persons with Disabilities, of the 2.6 million people with physical disabilities in China, two groups have the largest proportion: cerebrovascular disease and joint disease. For children, complete control and functional protection of joint inflammation is of crucial importance for their later quality of life. It is a heterogeneous group of diseases that includes seven subtypes, namely systemic, oligoarticular, polyarticular, rheumatoid factor negative, polyarticular, rheumatoid factor positive, psoriasis-associated, attachment point-associated and undifferentiated, with the oligoarticular type having a relatively good prognosis. The clinical features of adult rheumatic arthritis (RA) are similar to only one type of JIA, polyarticular, rheumatoid factor-positive, while the clinical features and treatment options of the other six subtypes vary. The difficulties in the treatment of JIA are systemic JIA, polyarticular JIA and JIA with attachment points. Traditional glucocorticoids and synthetic disease-modifying anti-rheumatic drugs (DMARDs) often fail to bring the disease under rapid and satisfactory control. In the last decade or so, advances in the treatment of rheumatic diseases have rapidly entered the era of targeted therapy with biologic agents that directly target various inflammatory factors with clearer anti-inflammatory targets and faster onset of action, such as tumor necrosis factor antagonists, IL-1 and IL-6 antagonists, etc., resulting in significant improvements in the efficacy of refractory JIA. However, there are still many misconceptions about the diagnosis and treatment of juvenile idiopathic arthritis, including the following: Myth 1: “Juvenile” idiopathic arthritis does not persist into adulthood People often believe that juvenile arthritis will “heal” naturally and does not require special treatment. Of the seven subtypes of JIA, only persistent oligoarticular JIA has the best prognosis, is mostly self-limiting, and rarely persists into adulthood, while other subtypes of JIA persist into adulthood in varying proportions. Data in adults show that 75% of patients with rheumatoid arthritis develop bone destruction within two years of onset, and up to 80% of patients can become disabled 20 years after onset, so the degree of remission and treatment of JIA in childhood affects, to some extent, joint function and whether it leads to poor outcomes in adulthood. The best time for treatment is recommended to be during the window period, before non-reversible bone erosion of the bone occurs. If the diagnosis is delayed or informal treatment is sought, as time passes and bone erosion progresses, even if treatment is started, it can only prevent new bone erosion from occurring, and it is often more difficult to completely reverse existing bone destruction. Unlike adults, infants and young children are rarely able to verbalize the location and nature of their pain, they generally adopt protective positions, and they do not even cry if the pain is not severe enough to affect their activities. It is up to the attentive parent to detect “telltale signs” such as an abnormal gait (may involve the hip, knee, or ankle), reluctance to lift the head or neck (may involve the cervical spine), reluctance to reach or lift the hand (may involve the wrist, elbow, or shoulder), salami-like swollen red fingers or toes, or inability to open the mouth to eat an apple (may involve the temporomandibular joint), etc. Even older children who are able to express themselves will usually only complain of “soreness” and “discomfort” because their pain threshold is often greater than that of adults, so parents need to learn to “feel” (is the skin temperature high? Is it high?) Therefore, parents should also learn to “feel” (is the skin temperature high?), “compare” (compare with the corresponding joint on the opposite side, is there any swelling) and “move” (move the joint, is there any restriction of movement). If you find any problems, go to a pediatric rheumatology specialist promptly. Persistent, recurrent joint pain that occurs after a traumatic injury is extremely easy to overlook. In some patients, the first symptom is after trauma, but after excluding surgical emergencies such as fractures, when topical and internal antipyretic analgesics are given that are ineffective or ineffective, or even when other joint involvement occurs, the patient’s parents often blame it on lack of rest and delay the diagnosis. Asking about extra-articular symptoms and family history is also very important for the diagnosis of arthritis. Because JIA is a heterogeneous group of diseases, in addition to arthralgic manifestations, attention should be paid to the presence of unexplained flaccid fever, rash with fever (generalized type), specific rash or family history of skin disease (psoriasis-related type), family history of ankylosing spondylitis, history of chronic abdominal pain or bloody stools (attachment point-related type), family history of rheumatoid arthritis (polyarticular type) The rheumatoid factor is positive), etc., which is very important for the diagnosis, classification and treatment of the disease. The goal of JIA treatment is to control joint inflammation as quickly and completely as possible and to effectively stop the onset and progression of bone erosion. Many parents think that arthritis is “under control” when they find that their child’s complaints of joint pain have significantly decreased or even disappeared after treatment. Even if there are no lesions on joint examination, more sophisticated tests, such as ultrasound, are still needed to determine whether there is bone erosion (bone destruction) and inflammatory lesions (abundant blood flow signals). Myth 4: Children with juvenile arthritis do not need regular eye examinations Unlike adults with rheumatoid arthritis, patients with JIA are recommended to have regular (every three months after onset, at least two years) slit lamp eye examinations to clarify the presence or absence of uveitis. Missed or prolonged refractory uveitis carries a risk of blindness. Because the onset of uveitis often does not parallel arthritic activity, it can also occur without any symptoms (photophobia, tearing, red eyes, etc.). It is also more likely to occur in younger children, in females, in ANA-positive and oligoarthritic children, and should be taken more seriously. Even some experienced ophthalmologists may refer children with unexplained, difficult-to-treat uveitis to pediatric rheumatology. With the advent of targeted biologic therapy, children with previously intractable forms of juvenile idiopathic arthritis have the opportunity to better control their disease and avoid the risk of “disability” and “blindness”. Patients who have been on hormones always think of them as a “magic bullet” that will bring the disease under control quickly and cheaply. However, except for systemic JIA, the use of hormones is generally not recommended because they do not stop the progression of bone erosion and have many side effects, such as obesity, delayed growth, osteoporosis, high intraocular pressure, cataracts, and so on. Even in systemic JIA, if hormone reduction is not possible within 6 months, it is necessary to consider adding other immunosuppressive agents or biologics to help reduce hormone dosage. Biologics can target the causative agent and have a very rapid onset of action and are more effective than traditional DMARDs, but the duration of treatment generally varies from one year to several years depending on the subtype and disease control. Only after the inflammatory lesions are completely “quiescent” can we begin to gradually reduce the type and dose of medications in order to achieve “minimal” medications and “minimal” doses to maintain a “disease-free” state. “disease-free” state. Since biologics are relatively expensive and not yet covered by medical insurance in most provinces and municipalities, many patients often find it difficult to persist until the disease is fully controlled, and once they stop using them, there is still the possibility of chronic inflammation persisting or even relapsing. There are many types of biologics available, and once a biologic is judged to be ineffective, other types can still be used, but their effectiveness will gradually diminish. In order to reduce the disability of children due to JIA, we, as pediatric rheumatologists, strongly urge for “early diagnosis, early treatment, standardized treatment, and regular follow-up”, so that every child with JIA can go to school normally and exercise freely.