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:

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	At least 2 positive tests for rheumatoid factor, at least 3 months apart Rheumatoid nodules 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 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