Last reviewed: 7 Nov 2021
Last updated: 07 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • more than 6 weeks' duration
  • joint pain
  • joint swelling
  • fever

Other diagnostic factors

  • morning stiffness
  • limp
  • limited movement
  • rash
  • enthesitis
  • limb length discrepancy
  • uveitis
  • rheumatoid nodules

Risk factors

  • female sex
  • HLA polymorphism
  • age under 6 years
  • family history of autoimmunity
  • antibiotic exposure in childhood

Diagnostic investigations

1st investigations to order

  • FBC
  • erythrocyte sedimentation rate
  • C-reactive protein
  • antinuclear antibodies (ANA)
  • rheumatoid factor (RF)

Investigations to consider

  • anti-cyclic citrullinated peptide antibody
  • chlamydia test
  • ferritin levels
  • ultrasound of affected joints
  • MRI

Treatment algorithm

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.

Acknowledgements

Dr Jacqui Clinch 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. 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 monograph. 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.

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