Juvenile Idiopathic Arthritis Symptoms

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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:

Symptoms of different types of JIA
Effects of disease Joints affected Eye disease (chronic uveitis) Other possible 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.
  • Risk is higher, especially 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 lengths
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
  • Risk is higher, especially 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
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 complications
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)
  • May develop low back and buttock pain and inflammation
  • May have antigen called HLA-B27 in the blood
  • May have family history of a condition related to HLA-B27, such as ankylosing spondylitis
Psoriatic JIA
  • Small and medium joints
  • Asymmetric joint symptoms
  • Sometimes
  • Psoriasis
  • 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

Related Information

References

Other Works Consulted

  • Hashkes PJ, Laxer RM (2005). Medical treatment of juvenile ideopathic arthritis. JAMA, 294(13): 1671–1684.
  • Hsu JJ, et al. (2013). Treatment of juvenile idiopathic arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1752–1770. Philadelphia: Saunders.
  • 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.

Credits

ByHealthwise Staff

Primary Medical Reviewer Susan C. Kim, MD - Pediatrics

E. Gregory Thompson, MD - Internal Medicine

Martin J. Gabica, MD - Family Medicine

Specialist Medical Reviewer John Pope, MD - Pediatrics

Current as ofFebruary 24, 2016