The most common symptoms of all forms of juvenile rheumatoid arthritis (JRA) include:
- Joint pain and swelling that may come and go but are most often persistent.
- Joint stiffness in the morning.
- Irritability, refusal to walk, or protection or guarding of a joint. You might notice your child limping or trying not to use a certain joint.
- Often unpredictable changes in symptoms, from periods with no symptoms (remission) to flare-ups.
Even though pain is a common symptom of JRA, a child may not identify pain as a problem. A child may be unable to describe pain or may become accustomed to the presence of pain. The child may be more alarmed by symptoms such as stiffness and may be better able to describe those symptoms. Some researchers believe that some children who have repeated medical procedures that cause pain may be afraid of further doctor visits and more anxious about their illness.2 This could cause them to not express or identify their pain because of fear of medical procedures.
Additional symptoms vary depending on which type of JRA a child has.
Eye disease usually causes no symptoms before permanent vision loss occurs. For this reason, it is very important for a child with JRA to have eye examinations with an ophthalmologist to detect developing eye damage so that treatment can be started before permanent vision problems occur. If symptoms are present, they may be as mild as painless red eyes, or the symptoms can include blurred vision, eye pain, sensitivity to light, and vision loss.
Fever spikes caused by systemic JRA typically reach 103°F (39.5 °C) to 106°F (41 °C), one to two times daily, with a fall to normal between spikes.
Rash caused by systemic JRA is spotty, flat, and sometimes faint red or pink and may occur with the fever. It may erupt over the torso, face, palms, soles of feet, and armpits. The rash often comes and goes and may appear late in the day or in the early morning. It may also be brought on by warm baths or by rubbing or scratching the skin.
Other conditions with similar symptoms to JRA include growing pains, overuse, injury, bone infection, and certain inflammatory diseases, among others. Many conditions can cause painful, stiff joints in children. Most often, occasional joint pain in children is related to an injury or aggravating factors, such as repetitive overuse in sports activities. JRA is a relatively uncommon cause of these symptoms.
Some children have forms of chronic arthritis that are similar to yet distinct from juvenile rheumatoid arthritis. These conditions, called spondyloarthropathies, are not addressed in this topic. Examples of spondyloarthropathies are ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis.