Symptoms of juvenile rheumatoid arthritis

The most common symptoms of all forms of juvenile rheumatoid arthritis (JRA) include:

  • Joint pain and swelling that may come and go but is most often persistent. Symptoms must last for 6 weeks before a diagnosis of JRA can be made.
  • Joint stiffness that lasts longer than 1 hour in the morning.
  • Irritability, refusal to walk, or protection or guarding of a joint. You might notice your child limping or avoiding the use of a certain joint.
  • Often unpredictable changes in symptoms, from periods with no symptoms (remission) to flare-ups.

Additional symptoms vary depending on which type of JRA a child has:1, 2

Symptoms of different types of JRA
Effects of disease Pauciarticular JRA/Oligoarthritis Polyarticular JRA/Polyarthritis Systemic arthritis
Joints affected during first 6 months of active disease
  • 1 to 4 joints affected, often one large joint initially
  • Knee most commonly affected
  • Also may affect the ankles, fingers, toes, wrists, elbows
  • Asymmetric joint symptoms (for example, one knee)
  • 5 or more joints affected
  • Knee and hip most commonly affected
  • Also affects the hands, wrists, spine, neck, or jaw
  • Symmetric joint symptoms (for example, both knees)
  • Bone growth problems
Joint swelling and pain not necessarily present at onset; eventually affects a few or many joints
Joints affected after first 6 months of active disease
  • 20% of children develop symptoms in more joints (extended oligoarthritis).
  • Most children have no more than 4 joints affected long-term (persistent oligoarthritis).

5 or more joints affected

Increase in number of joints affected over time
Whole-body (systemic) symptoms Not usually Mild to none Yes (including once- or twice-daily fever spikes, generalized body pain, rash, mild appetite loss, fatigue, and weakness)

Rheumatoid nodules


Yes, in children with polyarthritis who have a certain protein (rheumatoid factor) in their blood

Eye disease (chronic uveitis) At least 5 to 15%, with the risk higher in girls than in boys 5% Rare


  1. 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.
  2. Cassidy JT (2005). Juvenile rheumatoid arthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1579–1596. Philadelphia: Elsevier Saunders.

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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