Introdução: A Artrite Idiopática Juvenil (AIJ) inicia-se principalmente no intervalo etário de oito a catorze anos, podendo estar associada a déficit de crescimento e atraso puberal. O estadiamento de Tanner e a avaliação ultrassonográfica da pelve podem detectar atrasos no desenvolvimento puberal. Objetivos: Comparar a maturação sexual das meninas com AIJ a controles saudáveis, por meio da avaliação clínica dos estágios de Tanner e dos parâmetros da ultrassonografia (US) pélvica e relacionar esses achados aos níveis de hormônios sexuais e fatores relacionados à doença. Comparar, também, os dados antropométricos e a idade da menarca entre os dois grupos e relacioná-los a fatores de risco ligados à AIJ. Delineamento: Estudo transversal com grupo controle Metodologia: O estudo foi realizado com 44 meninas com AIJ e 59 controles com idades entre seis e dezoito anos incompletos, sem uso de glicocorticoides há no mínimo seis meses e sem outras doenças crônicas concomitantes. O diagnóstico de AIJ foi realizado de acordo com critérios da Liga Internacional das Associações de Reumatologia (ILAR). Foi realizada avaliação antropométrica, e a maturação sexual foi avaliada por meio dos estádios de Tanner. A US pélvica abdominal foi utilizada para avaliar as medidas do útero dos ovários e o índice de pulsatilidade das artérias uterinas (IP). Foram medidos níveis hormonais de FSH, LH, estrógeno, progesterona e IGF-1 nas meninas com AIJ. Resultados: Os parâmetros da US pélvica foram correlacionados aos estágios de Tanner no grupo controle (p <0,001). Todas as medidas de útero e ovários foram menores nas meninas com AIJ quando comparadas ao grupo controle. A média do IP das artérias uterinas foi maior nas meninas com AIJ. Estratificando-se por idade, o volume do útero foi menor nas meninas com AIJ na faixa etária de 10-11 anos (p < 0,004) e 14-15 anos (p=0,042), e a relação corpo/cérvice AP foi menor no intervalo de 10-11 anos (p=0,007). Os níveis de LH e estradiol foram fortemente relacionados ao aumento dos órgãos pélvicos (p<0,001) e inversamente com IP médio das artérias uterinas (p<0.01). O escore z do IMC e da estatura foi menor nas meninas com AIJ em relação ao grupo controle (p=0,032 e p=0,041 respectivamente). As meninas com AIJ poliarticular e com maior dose cumulativa de glicocorticoide apresentaram a maior chance de ter baixa estatura. Não houve diferença entre os grupos AIJ e controles com relação à idade da menarca. A altura final e a diferença entre essa altura e a altura-alvo familiar não foi diferente entre as meninas com AIJ e as do grupo controle. Conclusão: Nosso estudo mostrou que, mesmo sem uso de glicocorticoide há mais de seis meses, as crianças com formas mais graves de AIJ e que necessitaram de doses maiores de glicocorticoide estão mais suscetíveis ao retardo no crescimento e atraso no início da puberdade. A US pélvica demonstrou ser um exame sensível para avaliação da maturação sexual de meninas, identificando atrasos nas meninas com AIJ não percebidas por meio da avaliação clínica pelos estágios de Tanner. / Introduction: Juvenile Idiopathic Arthritis (JIA) manifests at the 8 to 14-year age span and is often associated with growth deficit and puberty delay. Tanner staging and pelvic ultrasonography (US) can be used to detect pubertal delays. Objectives: To compare sexual maturation in JIA girls and healthy controls (HC) by clinical evaluation with Tanner stages and pelvic US parameters and to correlate these findings with sexual hormone levels and disease related factors. Additionally, to compare anthropometric data and menarche age between groups and to correlate such findings with disease related risk factors in JIA patients. Study design: Cross-sectional study. Methods: 44 JIA and 59 healthy girls, aged six to 18 years, free of steroid use in the last six months and with no concomitant chronic diseases were included the study. JIA was diagnosed after the International League of the Rheumatology Associations (ILAR) criteria. Anthropometric and sexual development evaluations by Tanner staging were performed Pelvic US was performed to measure uterus, endometrial thickness, ovaries and uterine artery pulsatility index. Sexual hormone levels were measured in JIA girls. Results: Pelvic US parameters correlated with Tanner stages in HC (p <0.001). All uterine and ovarian measurements were smaller in JIA girls than in HC. Mean uterine artery PI was greater in JIA girls. Uterine volume was smaller in JIA girls at the 10 to 11 (P=0.004) and 14 to 15 year (p=0.042) age strata and the anteroposterior body cervix ratio was smaller in JIA girls the 10 to 11 year stratum (p=0.007). LH and estradiol levels were strongly correlated with pelvic organ size. (P<0.001) and inversely correlated with mean uterine artery PI (p<0.01) BMI and height for age z scores were smaller in JIA girls than in HC. Polyarticular JIA girls and those that had received greater steroid doses had the largest chance to have short stature. There was no difference between JIA girls and HC regarding menarche age. Final height and the final height/target height difference was not different between JIA girls and HC. Conclusion: The current study showed that JIA girls from the most severe subtypes and those that had received the largest steroid cumulative doses were more susceptible to growth and puberty delays, even six months after drug withdrawal. Pelvic US was a sensitive tool in detecting sexual development in girls, being able to identify puberty delays, unsuspected by Tanner stage evaluation.

Orientador: Claudia Saad Magalhães / Banca: Silvana Brasília Sacchetti / Banca: José Eduardo Corrente / Resumo: Objetivo: Caracterizar a atividade inflamatória articular e sistêmica na Artrite Idiopática Juvenil (AIJ), determinando o estado de remissão com e sem uso de medicação. Métodos: Cento e sessenta e cinco casos de AIJ classificados segundo os critérios de 2004 da Liga Internacional de Associações de Reumatologia (ILAR), acompanhados no serviço de Reumatologia Pediátrica FMB-UNESP, entre 1986 e 2005 com uma média de seguimento de 3,6 anos, foram revisados para caracterização de episódios de inatividade, remissão clínica com e sem uso de medicação, selecionando-se aqueles com acompanhamento mínimo de 1 ano. Foram analisados os descritores dos subtipos de AIJ. A freqüência de inatividade e remissão, para a comparação entre os subtipos de artrite e dos grupos que atingiram ou não remissão foram analisados por meio de estatística descritiva, análise de sobrevida por curvas de Kaplan-Meier, comparação das curvas por teste Log Rank e a análise de regressão logística para identificação de fatores preditivos para a remissão ou persistência de atividade. Resultados: Cento e oito casos preencheram os critérios de inclusão, sendo 58,3% oligoarticular persistente, 8,3% oligoarticular estendido, 1,8% poliarticular fator reumatóide positivo (FR+), 10,2% poliarticular reumatóide negativo (FR-), 12% sistêmico, 0,9% artrite psoriásica, 4,6% artrite relacionada a entesite, e 3,7% artrite indiferenciada. Dez por cento apresentavam anticorpos antinucleares (AAN) e 7,4% apresentavam uveíte. Cinqüenta e sete pacientes apresentaram um total de 71 episódios de inatividade durante o acompanhamento, com 2,9 anos em média para cada episódio. Trinta e seis episódios (50,7%) de inatividade resultaram em remissão clínica sem medicação (RC), sendo 35% para oligoarticular persistente. A probabilidade de remissão clínica em uso de medicação em 3 anos foi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To estimate the clinical remission on medication and off medication rates in Juvenile Idiopathic Arthritis (JIA) by determining the articular and systemic inflammatory activity. Methods: One hundred and sixty five cases of JIA, classified according to the 2004 International League of Associations for Rheumatology criteria, attending the Rheumatology Unit FMB-UNESP from 1986 to 2005, with median follow up 3,6 years, were reviewed for recording inactive disease, clinical remission on medication and clinical remission off medication. Cases with at least one year of regular follow up were selected. All JIA subtypes descriptors were evaluated. Inactivity and remission rates were compared by survival analyses with Kaplan-Meier curves and Log Rank test. Remission predictors and risk factors for persistent activity were identified by logistic regression analysis. Results: One hundred and eight cases met the inclusion criteria, being 58,3% persistent oligoarticular, 8,3% extended oligoarticular, 1,8% polyarticular rheumatoid factor positive (RF+), 10,2% polyarticular rheumatoid factor negative (RF-), 12% systemic, 0,9% psoriatic arthritis, 4,6% enthesitis related arthritis and 3,7% undifferentiated arthritis. Ten percent had antinuclear antibodies (ANA) and 7,4% had uveitis. Fifty-seven patients experienced a total of 71 episodes of inactive disease (ID), during the entire follow-up, with a median episode duration of 2,9 years. The patients attained inactive disease from one to four times. Thirty-six episodes (50,7%) of ID resulted in clinical remission (CR) off medication, being 35% for persistent oligoarticular. The probability of clinical remission on medication (CRM) within 3 years, was 63%, 83% and 60%, respectively for persistent oligoarticular, polyarticular and systemic arthritis cases. The probability of clinical remission... (Complete abstract click eletronic address below) / Mestre

Made available in DSpace on 2014-06-11T19:28:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-10-04Bitstream added on 2014-06-13T19:15:52Z : No. of bitstreams: 1 fernandes_tap_me_botfm.pdf: 1114659 bytes, checksum: ff36108431619df300e64aa654703f1d (MD5) / Objetivo: Caracterizar a atividade inflamatória articular e sistêmica na Artrite Idiopática Juvenil (AIJ), determinando o estado de remissão com e sem uso de medicação. Métodos: Cento e sessenta e cinco casos de AIJ classificados segundo os critérios de 2004 da Liga Internacional de Associações de Reumatologia (ILAR), acompanhados no serviço de Reumatologia Pediátrica FMB-UNESP, entre 1986 e 2005 com uma média de seguimento de 3,6 anos, foram revisados para caracterização de episódios de inatividade, remissão clínica com e sem uso de medicação, selecionando-se aqueles com acompanhamento mínimo de 1 ano. Foram analisados os descritores dos subtipos de AIJ. A freqüência de inatividade e remissão, para a comparação entre os subtipos de artrite e dos grupos que atingiram ou não remissão foram analisados por meio de estatística descritiva, análise de sobrevida por curvas de Kaplan-Meier, comparação das curvas por teste Log Rank e a análise de regressão logística para identificação de fatores preditivos para a remissão ou persistência de atividade. Resultados: Cento e oito casos preencheram os critérios de inclusão, sendo 58,3% oligoarticular persistente, 8,3% oligoarticular estendido, 1,8% poliarticular fator reumatóide positivo (FR+), 10,2% poliarticular reumatóide negativo (FR-), 12% sistêmico, 0,9% artrite psoriásica, 4,6% artrite relacionada a entesite, e 3,7% artrite indiferenciada. Dez por cento apresentavam anticorpos antinucleares (AAN) e 7,4% apresentavam uveíte. Cinqüenta e sete pacientes apresentaram um total de 71 episódios de inatividade durante o acompanhamento, com 2,9 anos em média para cada episódio. Trinta e seis episódios (50,7%) de inatividade resultaram em remissão clínica sem medicação (RC), sendo 35% para oligoarticular persistente. A probabilidade de remissão clínica em uso de medicação em 3 anos foi... / Objective: To estimate the clinical remission on medication and off medication rates in Juvenile Idiopathic Arthritis (JIA) by determining the articular and systemic inflammatory activity. Methods: One hundred and sixty five cases of JIA, classified according to the 2004 International League of Associations for Rheumatology criteria, attending the Rheumatology Unit FMB-UNESP from 1986 to 2005, with median follow up 3,6 years, were reviewed for recording inactive disease, clinical remission on medication and clinical remission off medication. Cases with at least one year of regular follow up were selected. All JIA subtypes descriptors were evaluated. Inactivity and remission rates were compared by survival analyses with Kaplan-Meier curves and Log Rank test. Remission predictors and risk factors for persistent activity were identified by logistic regression analysis. Results: One hundred and eight cases met the inclusion criteria, being 58,3% persistent oligoarticular, 8,3% extended oligoarticular, 1,8% polyarticular rheumatoid factor positive (RF+), 10,2% polyarticular rheumatoid factor negative (RF-), 12% systemic, 0,9% psoriatic arthritis, 4,6% enthesitis related arthritis and 3,7% undifferentiated arthritis. Ten percent had antinuclear antibodies (ANA) and 7,4% had uveitis. Fifty-seven patients experienced a total of 71 episodes of inactive disease (ID), during the entire follow-up, with a median episode duration of 2,9 years. The patients attained inactive disease from one to four times. Thirty-six episodes (50,7%) of ID resulted in clinical remission (CR) off medication, being 35% for persistent oligoarticular. The probability of clinical remission on medication (CRM) within 3 years, was 63%, 83% and 60%, respectively for persistent oligoarticular, polyarticular and systemic arthritis cases. The probability of clinical remission... (Complete abstract click eletronic address below)

Introdução: A Artrite Idiopática Juvenil (AIJ) inicia-se principalmente no intervalo etário de oito a catorze anos, podendo estar associada a déficit de crescimento e atraso puberal. O estadiamento de Tanner e a avaliação ultrassonográfica da pelve podem detectar atrasos no desenvolvimento puberal. Objetivos: Comparar a maturação sexual das meninas com AIJ a controles saudáveis, por meio da avaliação clínica dos estágios de Tanner e dos parâmetros da ultrassonografia (US) pélvica e relacionar esses achados aos níveis de hormônios sexuais e fatores relacionados à doença. Comparar, também, os dados antropométricos e a idade da menarca entre os dois grupos e relacioná-los a fatores de risco ligados à AIJ. Delineamento: Estudo transversal com grupo controle Metodologia: O estudo foi realizado com 44 meninas com AIJ e 59 controles com idades entre seis e dezoito anos incompletos, sem uso de glicocorticoides há no mínimo seis meses e sem outras doenças crônicas concomitantes. O diagnóstico de AIJ foi realizado de acordo com critérios da Liga Internacional das Associações de Reumatologia (ILAR). Foi realizada avaliação antropométrica, e a maturação sexual foi avaliada por meio dos estádios de Tanner. A US pélvica abdominal foi utilizada para avaliar as medidas do útero dos ovários e o índice de pulsatilidade das artérias uterinas (IP). Foram medidos níveis hormonais de FSH, LH, estrógeno, progesterona e IGF-1 nas meninas com AIJ. Resultados: Os parâmetros da US pélvica foram correlacionados aos estágios de Tanner no grupo controle (p <0,001). Todas as medidas de útero e ovários foram menores nas meninas com AIJ quando comparadas ao grupo controle. A média do IP das artérias uterinas foi maior nas meninas com AIJ. Estratificando-se por idade, o volume do útero foi menor nas meninas com AIJ na faixa etária de 10-11 anos (p < 0,004) e 14-15 anos (p=0,042), e a relação corpo/cérvice AP foi menor no intervalo de 10-11 anos (p=0,007). Os níveis de LH e estradiol foram fortemente relacionados ao aumento dos órgãos pélvicos (p<0,001) e inversamente com IP médio das artérias uterinas (p<0.01). O escore z do IMC e da estatura foi menor nas meninas com AIJ em relação ao grupo controle (p=0,032 e p=0,041 respectivamente). As meninas com AIJ poliarticular e com maior dose cumulativa de glicocorticoide apresentaram a maior chance de ter baixa estatura. Não houve diferença entre os grupos AIJ e controles com relação à idade da menarca. A altura final e a diferença entre essa altura e a altura-alvo familiar não foi diferente entre as meninas com AIJ e as do grupo controle. Conclusão: Nosso estudo mostrou que, mesmo sem uso de glicocorticoide há mais de seis meses, as crianças com formas mais graves de AIJ e que necessitaram de doses maiores de glicocorticoide estão mais suscetíveis ao retardo no crescimento e atraso no início da puberdade. A US pélvica demonstrou ser um exame sensível para avaliação da maturação sexual de meninas, identificando atrasos nas meninas com AIJ não percebidas por meio da avaliação clínica pelos estágios de Tanner. / Introduction: Juvenile Idiopathic Arthritis (JIA) manifests at the 8 to 14-year age span and is often associated with growth deficit and puberty delay. Tanner staging and pelvic ultrasonography (US) can be used to detect pubertal delays. Objectives: To compare sexual maturation in JIA girls and healthy controls (HC) by clinical evaluation with Tanner stages and pelvic US parameters and to correlate these findings with sexual hormone levels and disease related factors. Additionally, to compare anthropometric data and menarche age between groups and to correlate such findings with disease related risk factors in JIA patients. Study design: Cross-sectional study. Methods: 44 JIA and 59 healthy girls, aged six to 18 years, free of steroid use in the last six months and with no concomitant chronic diseases were included the study. JIA was diagnosed after the International League of the Rheumatology Associations (ILAR) criteria. Anthropometric and sexual development evaluations by Tanner staging were performed Pelvic US was performed to measure uterus, endometrial thickness, ovaries and uterine artery pulsatility index. Sexual hormone levels were measured in JIA girls. Results: Pelvic US parameters correlated with Tanner stages in HC (p <0.001). All uterine and ovarian measurements were smaller in JIA girls than in HC. Mean uterine artery PI was greater in JIA girls. Uterine volume was smaller in JIA girls at the 10 to 11 (P=0.004) and 14 to 15 year (p=0.042) age strata and the anteroposterior body cervix ratio was smaller in JIA girls the 10 to 11 year stratum (p=0.007). LH and estradiol levels were strongly correlated with pelvic organ size. (P<0.001) and inversely correlated with mean uterine artery PI (p<0.01) BMI and height for age z scores were smaller in JIA girls than in HC. Polyarticular JIA girls and those that had received greater steroid doses had the largest chance to have short stature. There was no difference between JIA girls and HC regarding menarche age. Final height and the final height/target height difference was not different between JIA girls and HC. Conclusion: The current study showed that JIA girls from the most severe subtypes and those that had received the largest steroid cumulative doses were more susceptible to growth and puberty delays, even six months after drug withdrawal. Pelvic US was a sensitive tool in detecting sexual development in girls, being able to identify puberty delays, unsuspected by Tanner stage evaluation.

Inflammatory arthritis (IA) types such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and psoriatic arthritis (PsA) have been shown to exhibit common clinical features. As complex diseases they have a known genetic component, some of which is known to be shared. The aim of this study was to assess the genetic overlap between 3 types of IA (RA, JIA and PsA) using genotype data generated on the Immunochip array and to select a biologically promising overlapping region for further genetic and functional investigation. Overlap analysis was performed using association data generated for a large cohort of inflammatory arthritis cases and shared controls (11,475 RA; 2816 JIA; 929 PsA respectively). 50 genetic regions were identified as being associated with more than 1 type of IA (p < 1x10-3), with several interesting similarities and differences observed between the diseases. As several of the overlapping regions detected represented novel disease associations, they required replication in an independent sample cohort. 12 variants were selected for replication in an independent RA cohort of 3879 cases and 2561 controls. Of these, 2 variants in the CTLA4 and MTMR3 regions were successfully replicated in RA at p<0.05. Bioinformatics analysis was performed for the 50 overlapping regions, with one particularly promising region, RUNX1, selected for further investigation. In this region, the same variant (rs9979383) is associated across the 3 diseases, with similar odds ratios (OR 0.8-0.9) observed in each disease. As this region represented both a novel IA association and had not been densely genotyped on the Immunochip array, fine mapping was performed by genotyping 51 SNPS in 3491 cases and 2359 controls. This resulted in replication of the association at rs9979383 (p=0.02) with no additional significant genetic effects detected, therefore this variant was selected for further functional analysis. As rs9979383 lies ~280kb upstream of the RUNX1 gene, a cis-eQTL analysis was performed to identify if the variant acts by regulation of RUNX1 gene expression. This was performed in whole blood, CD4+ and CD8+ lymphocytes from 75 (and a subset of 23) healthy volunteers respectively. No significant eQTLs were detected between rs9979383 and RUNX1 in whole blood (p =0.9) or RUNX1/LOC100506403 CD4+ and CD8+ lymphocytes (p=0.1). This study has provided insight into the genetic similarities and differences between different types of inflammatory arthritis, which can be applied to further investigations into disease susceptibility. Although no significant cis-eQTL was detected in any of these tissues with either RUNX1 or the nearby lnc-RNA LOC100506403, in cells from healthy volunteers under unstimulated conditions, these findings will direct future functional investigations into the role of this overlapping region in the susceptibility of IA.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most prevalent childhood rheumatic disease and significantly impacts a child’s well-being by potentially leading to disability and long-lasting effects. It consists of all forms of arthritis developing before the age of 16, therefore managing this disease is not simple. JIA can lead to a host of different medical problems over time and requires early attention and adequate treatment to prevent these long-term consequences. However, many children still experience pain after traditional treatment, indicating a need for alternative treatment modalities. Exercise therapy is one form of treatment that can potentially enhance a child’s quality of life. LITERATURE REVIEW FINDINGS: Multiple forms of exercise therapy have been shown to improve quality of life, functional ability and pain in patients with JIA. Exercise does not worsen disease activity, including the number of joints affected. While there are a limited number of studies in the JIA population, studies on patients with rheumatoid arthritis, a rheumatic disease diagnosed in adulthood, demonstrate the potential for exercise therapy to alter the pathophysiology of the disease and lead to better immune function. Exercise may have the ability to affect children with JIA in the same way as the two diseases share a similar pathophysiology. PROPOSED PROJECT: The goal of the proposed randomized control trial is to measure the impact of an exercise intervention on the quality of life of children with JIA, the effect exercise on participant immune function and variations in response between each subtype of JIA. Children will either complete high intensity interval walking training three times a week or no exercise intervention for 10 weeks. Various outcomes including quality of life, functional status, pain and fitness level will be measured before and after the intervention. Blood analysis to assess changes in immune function and further analysis between subtypes will also be conducted. CONCLUSIONS: The use of exercise therapy as a management tool for JIA should be considered earlier on in the disease course. It has not been found to worsen the disease and has produced increases in quality of life, functional status and pain. The benefits of this therapy are widespread and are not limited to healthy individuals. SIGNIFICANCE: This will be the first time these analyses will be performed and, if improvement is seen, this could help guide a physician’s disease management plan. Data from this study could provide information on how exercise modifies the disease and how to design more structured exercise programs appropriate to each subtype of JIA. Exercise may begin to be incorporated into the treatment plan for these children to increase disease remission rates, reduce the amount and severity of disease flares and provide both physical and psychological benefits.

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Bakgrund: JIA (juvenil idiopatisk artrit) är den vanligast förekommande reumatiska sjukdomen bland barn. Fysisk träning en viktig del av behandlingen där fysioterapeuten har huvudansvar. Tidigare forskning tyder på att barn med JIA inte är lika fysiskt aktiva som sina friska jämnåriga och att det i dagsläget saknas fördjupad kunskap om faktorer som påverkar fysisk aktivitet hos dessa barn.  Syfte: Syftet med arbetet var för vårdnadshavare för barn med JIA, utforska upplevelser och erfarenheter kring faktorer som påverkar barnets fysiska aktivitet.  Metod: Kvalitativ metod genom fem semistrukturerade intervjuer som genomfördes med vårdnadshavare till barn med JIA. Bekvämlighetsurval användes för att hitta deltagare. Materialet bearbetades genom en kvalitativ innehållsanalys.  Resultat: I analysen framkom fem kategorier med faktorer som påverkar fysisk aktivitet: hitta rätt – medicineringens roll i främjandet av fysisk aktivitet, upplevt ansvar att hitta och förmedla information, anpassningar i skolmiljö, uppmuntran och integration – vikten av normalitet i livet med JIA och önskemål kring utökade vårdinsatser.  Konklusion: Vårdnadshavare till barn med JIA erfarande att en adekvat medicinering var en faktor som främjade fysisk aktivitet. Vidare upplevde informanterna att de har ett stort ansvar att söka information om sjukdomen, samt att förmedla denna till berörda parter såsom skola och idrottsorganisationer för att främja sitt barns fysiska aktivitet. Otillräcklig kunskap om sjukdomen i samhället anses vara en hindrande faktor till att barnen kan vara fysiskt aktiva, medan lyhördhet och anpassningar i skola och idrottssammanhang var underlättande faktorer. Informanterna framförde önskemål om förbättrad kontinuitet i vården för att effektivisera behandlingen. / Background: JIA (juvenile idiopathic arthritis) is the most common rheumatic disease among children. Exercise is an important part of the treatment, and physiotherapists have primary responsibility for the treatment plan. Previous research suggests that children with JIA are not as physically active as their healthy peers, and currently, there is a lack of in-depth knowledge about factors that affect physical activity in children with JIA.  Objectives: The aim of this study was to explore the experiences of factors influencing a child's physical activity for guardians of children with JIA.  Method: A qualitative design was conducted through five semi-structured interviews with guardians of children with JIA. Convenience sampling was used to identify participants. The data was processed through qualitative content analysis.  Result: The analysis revealed five categories of factors that influence physical activity: the role of medication in promoting physical activity, guardians’ responsibility to find and convey information, adaptations in school environment, the importance of normalcy in life with JIA and preferences for expanded healthcare interventions.  Conclusion: Guardians of children with JIA experienced that adequate medication was a factor that facilitated physical activity. Moreover, the guardians of children with JIA felt that they had a responsibility to seek information about the disease and convey it to relevant parties such as schools and sports organizations to promote their child's physical activity. Insufficient knowledge about the disease in society was considered a hindering factor for children to be physically active, while awareness and adaptations in school and sports settings were facilitating factors. The informants expressed a desire for improved continuity in healthcare to streamline treatment.