Summary
Definition
History and exam
Key diagnostic factors
- over 6 weeks' duration
- joint pain
- joint swelling
- fever
Other diagnostic factors
- age under 6 years
- morning stiffness
- limp
- limited movement
- rash
- enthesitis
- limb length discrepancy
- uveitis
- rheumatoid nodules
Risk factors
- female sex
- human leukocyte antigen (HLA) polymorphism
- family history of autoimmunity
- antibiotic exposure in childhood
Diagnostic tests
1st tests to order
- CBC
- erythrocyte sedimentation rate
- C-reactive protein
- antinuclear antibodies (ANA)
- rheumatoid factor (RF)
Tests to consider
- anticyclic citrullinated peptide antibody
- chlamydia test
- ferritin levels
- ultrasound of affected joints
- MRI
Treatment algorithm
polyarticular JIA: 5 or more joints ever involved
oligoarticular JIA: 4 or fewer joints ever involved
active sacroiliitis
active enthesitis
systemic-onset JIA
Contributors
Authors
Jacqui Clinch, MRCP, FRCPCH
Consultant Paediatric Rheumatologist
Department of Paediatric Rheumatology
Bristol Royal Hospital for Children
Bristol
UK
Disclosures
JC declares that she has no competing interests.
Natasha Smallwood, MB, ChB, MRCPCH
Consultant Paediatric Medicine and Rheumatology
Department of Paediatric Rheumatology
Bristol Royal Hospital for Children
Bristol
UK
Disclosures
NS declares that she has no competing interests.
Acknowledgements
Dr Jacqui Clinch and Dr Natasha Smallwood would like to gratefully acknowledge Dr Ripal Shah, Dr Eve Bassett, Dr Sheila Angeles-Han, and Dr Sampath Prahalad, the previous contributors to this topic.
Disclosures
RS and EB declare that they have no competing interests. SAH and SP are authors of a number of references cited in this topic. SP is the recipient of research funding from the National Institute of Health and Arthritis Foundation.
Peer reviewers
Paul Rosen, MD
Clinical Director
Division of Pediatric Rheumatology
Children's Hospital of Pittsburgh
Pittsburgh
PA
Disclosures
PR declares that he has no competing interests.
Murray Passo, MD
Director
Division of Rheumatology
Professor of Pediatrics
Department of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
MP is an author of a number of references cited in this topic. He is a consultant to Pfizer Pharmaceuticals as the chairman of the Expert Advisory Panel to review toxicity of celecoxib. He has been a visiting professor from the American College of Rheumatology, and from the American Academy of Pediatrics.
Patricia Woo, CBE
Professor of Paediatric Rheumatology
University College London
London
UK
Disclosures
Not disclosed.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Davies K, Cleary G, Foster H, et al. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford). 2010 Jul;49(7):1406-8.Full text Abstract
Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011 Apr;63(4):465-82.Full text Abstract
Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: recommendations for nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Arthritis Care Res (Hoboken). 2022 Apr;74(4):505-20. Abstract
Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2022 Apr;74(4):521-37. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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