Medical History and Physical Exam for Juvenile Idiopathic Arthritis
The most important steps in diagnosing juvenile idiopathic arthritis (JIA) are the medical history and physical exam. Your child's doctor may ask some of the following questions:
- How long do symptoms last, both during a single day and over time?
- At what age did symptoms first begin?
- Which joints are affected? How many joints are affected?
- Are the same joints always affected or do symptoms move from one joint to another?
- What is the child's pain like?
- Does the child bear weight on the affected body part? Has the child's physical activity changed? Have you noticed any limping, favoring a limb, avoiding play, or crawling rather than walking?
- How is the child's general health? Has he or she been ill recently? Are whole-body (systemic) symptoms present, such as weight loss, weakness, or decreased appetite?
- Is there a family history of arthritis?
- Did an injury or illness (sore throat, diarrhea, or flu-like symptoms) occur before the symptoms started, or did the symptoms come on slowly over time?
- Has the child been bitten by a tick that may be a carrier of Lyme disease?
- Are there other symptoms (such as fever, fatigue, or rash) that occurred before or with joint symptoms?
The physical exam generally is not painful and includes:
- Checking body temperature, blood pressure, lymph nodes, and joints.
- Examining the heart and lungs with a stethoscope.
- Feeling the abdomen.
- Examining the skin.
Why It Is Done
A history and physical exam are a routine part of the evaluation of joint pain and stiffness. JIA is diagnosed only after a careful physical exam and medical history.
- Joints affected by JIA are often stiff in the morning and improve as the child uses the joint.
- Children usually bear weight on a joint affected by JIA despite the swelling.
- Joints affected by JIA tend to be less painful than those affected by other conditions, such as infection, injury, or cancer.
During the physical exam, the doctor will note:
- Joint problems, such as swelling, tenderness, or stiffness.
- The number and location of affected joints.
- Whether there are other symptoms (fever, rash, or fatigue).
Using the above information, your doctor may be able to clarify the diagnosis and the type of JIA. In many cases, your child may have symptoms for up to 6 months before the type of arthritis is diagnosed.
What To Think About
The diagnosis of juvenile idiopathic arthritis (JIA) requires ruling out other conditions. Information from the medical history and physical exam is very important to evaluate possible causes of symptoms and to select the best tests to rule out other conditions.