Although there are some tell-tale signs, Juvenile Rheumatoid Arthritis can be difficult to diagnose. Symptoms must persist for at least 6 weeks before doctors confirm a diagnosis of JRA. An observant parent will sometimes notice certain things that make them wonder if there might be something wrong. Upon awakening, a child may appear to have stiffness in their joints. They may notice what appears to be a slight limp or change in gait, although there has been no recent injury. A child may begin to complain about their legs feeling tired and aching ... which many assume, at first mention, to be growing pains. A very young child may revert to crawling. When holding and carrying objects, the child may grasp them in what appears to be an awkward way. Dressing by themself or brushing their hair may become more difficult and take a child longer to do.
Sometimes inflammation causes an affected joint to swell visibly and the surrounding area to redden. I've heard a few parents say their child's knee, for example, swelled to the size of a grapefruit. It's not always quite so obvious, though and children often compensate extremely well for any loss in range of motion. Children with JRA do not always complain of pain. Many very young children with JRA take for granted that how they feel is how everyone feels. They get used to the pain and go about their lives, figuring out different ways to do things if they have too much pain or trouble doing it the way others do. Things such as a child's reluctance to use a particular limb and/or reduced levels of activity can be important clues.
A number of other conditions can mimic Juvenile Rheumatoid Arthritis; most notably infections, musculoskeletal conditions, and other less common rheumatic disease. Further evaluation to exclude these are necessary before a diagnosis can be confirmed. There are certain tests that will likely be done, some of which are commonly used to help diagnose rheumatoid arthritis in adults. These are thought by some to be of limited value among pediatric patients, as children normally test negative for Rheumatoid factor in blood tests and rarely show visible joint changes in the very early stage. There will be physical exams, blood tests, possibly xrays, MRIs, and bone scans. Your schedule may, at least initially, be very busy with visits to various doctors and health care centers.
In the case of children with Systemic Juvenile Rheumatoid Arthritis (also known as Stills Disease), which is the type of arthritis my son Joshua has, the more common signs and symptoms of arthritis will usually be accompanied by high, spiking, fevers once or twice a day and a splotchy pink rash that appears on the trunk, back, thighs, arms, and/or various other parts of the body. The child may complain that they 'hurt all over' as this form of arthritis does often migrate to many areas of the body before 'settling' in particular joints. These children often present with neck stiffness, sore throat, enlarged lymph glands, and abdominal and/or chest pain, as well.
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