When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Juvenile idiopathic arthritis

Last reviewed: 4 Sep 2023
Last updated: 28 Sep 2023



History and exam

Key diagnostic factors

  • over 6 weeks' duration
  • joint pain
  • joint swelling
  • fever
More key diagnostic factors

Other diagnostic factors

  • age under 6 years
  • morning stiffness
  • limp
  • limited movement
  • rash
  • enthesitis
  • limb length discrepancy
  • uveitis
  • rheumatoid nodules
Other diagnostic factors

Risk factors

  • female sex
  • human leukocyte antigen (HLA) polymorphism
  • family history of autoimmunity
  • antibiotic exposure in childhood
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • erythrocyte sedimentation rate
  • C-reactive protein
  • antinuclear antibodies (ANA)
  • rheumatoid factor (RF)
More 1st investigations to order

Investigations to consider

  • anticyclic citrullinated peptide antibody
  • chlamydia test
  • ferritin levels
  • ultrasound of affected joints
  • MRI
More investigations to consider

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



Jacqui Clinch, MRCP, FRCPCH

Consultant Paediatric Rheumatologist

Department of Paediatric Rheumatology

Bristol Royal Hospital for Children




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




NS declares that she has no competing interests.


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.


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




PR declares that he has no competing interests.

Murray Passo, MD


Division of Rheumatology

Professor of Pediatrics

Department of Pediatrics

Medical University of South Carolina




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




Not disclosed.

  • Differentials

    • Septic arthritis
    • Osteomyelitis
    • Malignancy
    More Differentials
  • Guidelines

    • 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
    • 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: recommendations for nonpharmacologic therapies, medication monitoring, immunizations, and imaging
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer