Does your child complain of aching joints? Does he or she limp in the morning, have swollen knees or other joints warm to the touch, a spiking fever and/or an unexplainable rash? What some parents and health-care professionals may write off as "growing pains" could actually be juvenile rheumatoid arthritis, because kids get arthritis too! As diagnosing childhood rheumatoid arthritis is a difficult process, often taking more than a month to complete, your child’s doctor might initially misdiagnose it.

If you are reading this website, you may already suspect that your child has JRA. That is why recognizing the symptoms and taking your child to a qualified pediatric rheumatologist or to an adult rheumatologist who works with children (see list of pediatric rheumatologists in this website) are vitally important to the health of your child. They are major steps to get a correct diagnosis of JRA, to begin treatment as quickly as possible, to reduce symptoms and pain and to prevent the long-term damage that can result from this illness.

What are the symptoms and signs of juvenile rheumatoid arthritis?

There is not one single symptom, sign or test that will give a diagnosis of the illness. The most common symptom of all types of JRA is persistent joint swelling, pain and stiffness, often in the knees and joints of the hands and feet. These symptoms are typically worse in the morning or after a nap. While swelling and pain may limit movement of the affected joints, many children, especially younger ones, do not complain of the symptoms.

In addition to joint symptoms, children with systemic JRA often have high fevers and a light skin rash that appear and disappear quickly, along with swollen glands in the neck, armpits and groin. Very occasionally, inflammation can affect the covering of the heart, the heart muscle (myocarditis), the covering of the lungs or the lungs (pleuritis). A child in the early stages of JRA often has relatively little pain until you ask him or her to straighten a leg or bend it until it hurts. 

If your child’s eyesight is blurry, he or she might be in the beginning stages of a serious eye disorder. Eye inflammation, known as iritis or uveitis, a potentially severe complication that develops in some children with pauciarticular JRA, is often not present until sometime after a child first develops the illness. It is important, however, to have your child's eyes examined by a medical doctor who specializes in eye care (ophthalmologist) as soon as he or she is diagnosed with JRA.

Typically, there are periods when the symptoms of JRA improve or disappear (remissions). There are other times when symptoms are worse (flare-ups). JRA is different in each child; some may have just one or two flare-ups and never have symptoms again, while others experience many flare-ups or have symptoms that never go away.

Some children with JRA have growth problems. Depending on the severity of the illness and the joints involved, growth in affected joints may be too fast or too slow, causing one leg or arm to become longer than the other. Overall growth may also be slowed. (Doctors are exploring the use of growth hormones to treat this problem.) 

First signs

The first signs of JRA include: limping, a sore wrist, finger or knee, joints that suddenly swell and remain enlarged, stiffness in the neck, hips, or other joints, rashes that suddenly appear and disappear, and high fevers that tend to spike in the evenings and suddenly disappear.

Because joint swelling or pain must last for six weeks before a diagnosis of juvenile rheumatoid arthritis can be made, you the parent, recognizing and recording the frequency and length of time of specific symptoms, is vitally important in helping the doctor make a correct diagnosis. It may be useful to keep a record of symptoms, when they first appear, and when they improve or disappear. Watch for joint stiffness that lasts for longer than one hour in the morning, irritability, refusal to walk, or protection (guarding) of a joint.

Please realize that children who get a joint injury after playing a sport might limp for a week and then get better. Also, redness and swelling around a knee or other joint might or might not indicate JRA (again, children with a sports injury might have swelling at first). A joint can hurt for many different reasons, which is why it is important to see a doctor to figure out what the problem is.

Top 20 symptoms of JRA
Because JRA affects each child differently, your son or daughter will likely experience only some of the following symptoms. Children also vary in the degree to which they are affected by any particular symptom.

1. Morning stiffness
2. Fever
3. Inflammation of parts of the eyes
4. Deformities in the joints
5. Redness
6. Swollen lymph nodes
7. Anemia
8. Decreased growth
9. Poor vision
10. Swelling
11. Aching in the jaw
12. Complications of the organs
13. Rash
14. Light sensitivity
15. Feeling of heat in the joints
16. Pain
17. Presence of a limp
18. Depression
19. Weight loss
20. Myalgia (pain in the muscles)
    

Unpredictability

JRA can last for as little as several months or as long as a year and then disappear forever. In most cases, children endure up-and-down episodes for many years, depending on the type of arthritis. Flare-ups occur when the arthritis is getting worse. Remissions occur when the arthritis appears to have gone away. A mild virus such as the 'flu' may trigger a flare-up, but the cause of the flare-up is not usually identified. While it is upsetting to observe flare-ups, parents are wise to not give up hope and remain optimistic. Fortunately, for most children, flare-ups tend to become less severe and occur less often over time.

What can juvenile rheumatoid arthritis be confused with?

Because there are many causes of joint pain and swelling, the doctor must rule out other conditions before diagnosing JRA. Other conditions include physical injury, bacterial or viral infections, colds, Lyme disease (this initially produces similar symptoms to those of JRA, so please tell your doctor if your child has been in a tick-infested area), inflammatory bowel disease, lupus, dermatomyositis and some forms of cancer. The doctor may use laboratory tests to help rule out these and other possible conditions.