Juvenile idiopathic arthritis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Apr 2025

Last updated: 12 Jul 2024

Juvenile idiopathic arthritis (JIA) describes a group of chronic paediatric inflammatory arthritides. There are several subtypes, including oligoarticular, polyarticular, and systemic onset.

Affects 1 in 1000 children and can present at any age.

Diagnosis is made clinically. Laboratory and radiographic testing provide classification and prognostic information but are not diagnostic.

The primary goals of treatment are to relieve immediate pain and prevent joint damage and therefore disability. Intra-articular corticosteroids offer good control if only a few joints are affected. Methotrexate is the most commonly used conventional synthetic disease-modifying antirheumatic drug. Physiotherapy, occupational therapy, and psychology form an important aspect of management.

Around 10% to 20% of children with JIA are at risk of developing anterior uveitis. All children with a diagnosis of JIA must undergo regular ophthalmological examinations to detect and manage inflammation.

Definition

A collection of chronic paediatric inflammatory arthritides characterised by onset before 16 years of age and the presence of objective arthritis (in one or more joints) for at least 6 weeks.[1]

Arthritis of joints is defined by swelling or effusion, increased warmth, and/or painful limited movement with or without tenderness.

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic investigations

1st investigations to order

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

Full details

Investigations to consider

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

Full details

Treatment algorithm

ONGOING

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

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

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

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

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

Disclosures

Not disclosed.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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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Juvenile idiopathic arthritis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

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

Contributors

Authors

Jacqui Clinch, MRCP, FRCPCH

Disclosures

Natasha Smallwood, MB, ChB, MRCPCH

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Paul Rosen, MD

Disclosures

Murray Passo, MD

Disclosures

Patricia Woo, CBE

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice