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Juvenile Idiopathic Arthritis Symptoms

Topic Overview

The most common symptoms of all forms of juvenile idiopathic arthritis (JIA) include:

  • Joint pain and swelling that may come and go but are most often persistent. Symptoms must last for 6 weeks before a diagnosis of JIA 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 JIA a child has:1, 2

Symptoms of different types of JIA
Effects of disease Joints affected Eye disease (chronic uveitis) Other features
Oligoarticular JIA (persistent or extended)
  • 1 to 4 joints affected in the first 6 months
  • Knees and ankles most commonly affected
  • Asymmetric joint symptoms (for example, one knee)
  • In persistent oligoarthritis, 4 or fewer joints are affected after the first 6 months.
  • In extended oligoarthritis, 5 or more joints are affected after the first 6 months.
  • Up to 30 out of 100 children
  • Risk is higher in children who have antinuclear antibody (ANA) in their blood
  • Rarely have whole-body symptoms
  • Uneven leg bone growth possible, resulting in muscle wasting and legs of different lengths3
Polyarticular JIA, RF-negative
  • 5 or more joints affected in the first 6 months
  • Large and small joints
  • Neck and jaw often affected
  • Symmetric joint symptoms (for example, both knees) or asymmetric
  • About 10 out of 100 children
  • Risk is higher in children who have antinuclear antibody (ANA) in their blood
  • Bone growth problems
Polyarticular JIA, RF-positive
  • 5 or more joints affected in the first 6 months
  • Often affects small joints such as those in the hands
  • Symmetric and aggressive joint symptoms
  • Rare
  • At least 2 positive tests for rheumatoid factor, at least 3 months apart
  • Rheumatoid nodules in about 10 out of 100 children
  • Bone growth problems
  • High risk of problems as an adult
Systemic JIA
  • Joint swelling and pain not necessarily present at onset; eventually affects a few or many joints
  • Rare
  • Whole-body symptoms, including once- or twice-daily fever spikes; generalized body pain; rash; mild appetite loss; fatigue; weakness; and enlarged lymph nodes, liver, and spleen
  • Sometimes heart complications2
Enthesitis-related JIA
  • Both arthritis and enthesitis (tenderness where tendons and ligaments attach to bones)
  • Mostly legs and feet
  • Spine may be affected over time
  • Yes, but the frequency is unclear
  • May develop irritable bowel
  • May develop sacroiliac tenderness (where the spine meets the pelvis)1
  • May develop low back and buttock pain and inflammation1
  • May have antigen called HLA-B27 in the blood1
  • May have family history of a condition related to HLA-B27, such as ankylosing spondylitis1
Psoriatic JIA
  • Small and medium joints
  • Asymmetric joint symptoms
  • About 15 out of 100 children
  • Psoriasis in about 50 out of 100 children
  • May have problems with fingernails or toenails, including pitting of the nails or separation of the nail from the nail bed (onycholysis)
  • May have family history of psoriasis in a close relative

References

Citations

  1. Nistala K, et al. (2009). Juvenile idiopathic arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1657–1675. Philadelphia: Saunders Elsevier.
  2. 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.
  3. Hashkes PJ, Laxer RM (2005). Medical treatment of juvenile ideopathic arthritis. JAMA, 294(13): 1671–1684.

Credits

By Healthwise Staff
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
Specialist Medical Reviewer John Pope, MD - Pediatrics
Last Revised June 5, 2012

Last Revised: June 5, 2012

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