Classification of juvenile arthritis

There are two traditional classifications of juvenile arthritis: the European classification of juvenile chronic arthritis (JCA) and the American classification of juvenile rheumatoid arthritis (JRA). Because these classifications break down into different categories, European and American research findings and treatment recommendations are difficult to use interchangeably.1

In an effort to improve research and treatment, the International League Against Rheumatism has devised a unifying set of international criteria, using the term "juvenile idiopathic arthritis" (JIA). The word "idiopathic" means "of unknown cause." First proposed in 1995 and later revised in 1997, this classification is gaining favor among researchers and health professionals but is not yet universally used.

The table below summarizes the three classification systems.2, 1

Classification systems for juvenile arthritis
Organization Classification Length of illness before diagnosis
American College of Rheumatology Juvenile rheumatoid arthritis (JRA)
Systemic JRA
Polyarticular JRA (5 or more joints)
Pauciarticular JRA (1 to 4 joints)

JRA does not include similar types of childhood arthritis (juvenile ankylosing spondylitis, juvenile psoriatic arthritis).

6 weeks
European League Against Rheumatism Juvenile chronic arthritis (JCA)
Systemic JCA
Polyarticular JCA (5 or more joints, RF-negative)
Juvenile rheumatoid arthritis (5 or more joints, RF-positive)
Pauciarticular JCA (1 to 4 joints)
Juvenile psoriatic arthritis
Juvenile ankylosing spondylitis
3 months
International League Against Rheumatism Juvenile idiopathic arthritis (JIA)
Systemic JIA
Polyarticular JIA, RF-positive
Polyarticular JIA, RF-negative
Oligoarticular JIA
  • Persistent (1 to 4 joints)
  • Extended (eventually affecting 5 or more joints)
Psoriatic arthritis
Enthesis-related arthritis
Other arthritis
6 weeks

Regardless of the classification, children who develop symptoms before reaching 16 years of age are considered to have juvenile arthritis.

Citations

  1. Duffy CM, et al. (2005). Nomenclature and classification in chronic childhood arthritis. Arthritis and Rheumatism, 52(2): 382–385.
  2. Warren RW, et al. (2005). Juvenile idiopathic arthritis (Juvenile rheumatoid arthritis). In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1277–1300. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: June 25, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Michael J. Sexton, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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