Symptoms of juvenile rheumatoid arthritis

The most common symptoms of all forms of juvenile rheumatoid arthritis (JRA) include:

• Joint pain and swelling that may come and go but is most often persistent. Symptoms must last for 6 weeks before a diagnosis of JRA can be made.
• Joint stiffness that lasts longer than 1 hour in the morning.
• Irritability, refusal to walk, or protection or guarding of a joint. You might notice your child limping or avoiding the use of a certain joint.
• Often unpredictable changes in symptoms, from periods with no symptoms (remission) to flare-ups.

Additional symptoms vary depending on which type of JRA a child has:^{1, 2}

Symptoms of different types of JRA

Effects of disease	Pauciarticular JRA/Oligoarthritis	Polyarticular JRA/Polyarthritis	Systemic arthritis
Joints affected during first 6 months of active disease	1 to 4 joints affected, often one large joint initially Knee most commonly affected Also may affect the ankles, fingers, toes, wrists, elbows Asymmetric joint symptoms (for example, one knee)	5 or more joints affected Knee and hip most commonly affected Also affects the hands, wrists, spine, neck, or jaw Symmetric joint symptoms (for example, both knees) Bone growth problems	Joint swelling and pain not necessarily present at onset; eventually affects a few or many joints
Joints affected after first 6 months of active disease	20% of children develop symptoms in more joints (extended oligoarthritis). Most children have no more than 4 joints affected long-term (persistent oligoarthritis).	5 or more joints affected	Increase in number of joints affected over time
Whole-body (systemic) symptoms	Not usually	Mild to none	Yes (including once- or twice-daily fever spikes, generalized body pain, rash, mild appetite loss, fatigue, and weakness)
Rheumatoid nodules	No	Yes, in children with polyarthritis who have a certain protein (rheumatoid factor) in their blood	No
Eye disease (chronic uveitis)	At least 5 to 15%, with the risk higher in girls than in boys	5%	Rare

Citations

1. Warren RW, et al. (2005). Juvenile idiopathic arthritis (Juvenile rheumatoid arthritis). In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1277–1300. Philadelphia: Lippincott Williams and Wilkins.

2. Cassidy JT (2005). Juvenile rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1579–1596. Philadelphia: Elsevier Saunders.