Juvenile Rheumatic Arthritis / Juvenile Inflammatory Arthritis



Pauciarticular (most common)

Polyarticular JA (second most common)

Systemic (least common)

DDX: other arthritis (infectious, ARF, reactive, CVD). JRA is different in that the joint manifestations persist.

DX: do x-rays only to exclude trauma. RF rarely positive. ANA nonspecific.

Tx: aspirin, may sub other NSAID ie motrin, tolmetin, naprosyn. Steroids, limited role, 2nd line if nsaids can't control fever. Gold salts during chronic phase. Last line: cytotoxic agents (MTX, cyclosporin A), biologics (Anti-TNF). PT/OT.


Routine ophtho visits every few months for many years –depending on type of JIA and ANA status (generally every 3 months if ANA+ or <4y/o, every 6 months until 7y/o, and then annually if >7y/o without disease)

  1. 3 y/o female with unilateral knee involvement and evidence of uveitis on ophtho eval
  2. 13 y/o female with bilateral hand/ feet joint involvement and firm nodules over pressure points
  3. 10 y/o male with hip involvement and achilles tendonitis
  4. 5 y/o female with daily fever spikes, evanescent rash, and knee involvement


#1. Pauciarticular 1-Often ANA (+)
#2. Polyarticular –Expect RF (+)
#3. Pauciarticular 2 –Often HLA-B27 (+)
#4. Systemic JIA

CHLA Board Review 2005