Juvenile Arthritis: Early Signs and Symptoms
Learn the early signals that could indicate your child’s symptoms result from a juvenile rheumatic disease.
Young children often are sidelined by illness or fatigue – the flu-like bug picked up from playmates at day-care,
or the sore arm caused by a tumble on the playground. When symptoms like pain, stiffness or fevers occur at
odd times, without obvious cause, could this mean juvenile arthritis (JA)? How can you tell the difference?
Traditionally, a child complaining of occasional achy joints was dismissed as having “growing pains,” a vague phenomenon believed to be the result of the natural growth process. Now, we know that symptoms of joint pain, swelling, stiffness, fatigue or illness may be early signals of a serious, inflammatory rheumatic disease that
requires immediate medical treatment.
Several rheumatic diseases affect children, often those who are too young to speak about what’s bothering them.
In such cases, it’s important not to assume these symptoms are temporary, and to get a proper diagnosis from
your paediatrician. Early drug treatment can prevent serious, permanent damage to your child’s joints and
enable to her to live an active, full childhood despite juvenile arthritis.
Common Signs of JA
he most common type of juvenile arthritis is juvenile idiopathic arthritis, formerly known as juvenile
rheumatoid arthritis. Children as young as two may be affected. Other rheumatic diseases affecting children
include juvenile dermatomyositis, juvenile psoriatic arthritis, systemic lupus erythematous and systemic arthritis,
or Still’s disease. In these diseases, a child’s immune system malfunctions for some reason, attacking her body
instead, especially her joints. Here are the common symptoms of juvenile arthritis, and why they are different
from symptoms caused by other illnesses or injury.
Pain: Kids complain of pain in joints or muscles at times, particularly after a long day of strenuous activity.
But a child with juvenile arthritis may complain of Pain right after she wakes up in the morning or after a nap.
Her knees, hands, feet, neck or jaw joints may be painful. Her pain may lessen as she starts moving for the day.
Over-the-counter pain relief drugs like acetaminophen or ibuprofen may not help. Unlike pain caused by an injury
or other illnesses, JA-related pain may develop slowly, and in joints on both sides of the body (both knees or
both feet), rather than one single joint.
Stiffness: A child with JA may have stiff joints, particularly in the morning. He may hold his arm or leg in the
same position, or limp. A very young child may struggle to perform normal movements or activities he recently
learned, like holding a spoon. JA-related stiffness may be worse right after he wakes up and improve as
he starts moving.
Swelling: Swelling or redness on the skin around painful joints is a sign of inflammation. A child may complain
that a joint feels hot, or it may even feel warm to the touch. A child’s swelling may persist for several days, or
come and go, and may affect her knees, hands and feet. Unlike swelling that happens right after a fall or injury
during play, this symptom is a strong sign that she has juvenile arthritis.
Fevers: While children commonly have fevers caused by ordinary infectious diseases like the flu, a child with
JA may have frequent fevers accompanied by malaise or fatigue. These fevers don’t seem to happen along
with the symptoms of respiratory or stomach infections. Fevers may come on suddenly, even at the same
time of day, and then disappear after a short time.
Rashes: Many forms of juvenile arthritis cause rashes on the skin. Many kids develop rashes and causes can
range from poison ivy to eczema or even an allergic reaction to a drug. But faint, pink rashes that develop over
knuckles, across the cheeks and bridge of the nose, or on the trunk, arms and legs, may signal a serious
rheumatic disease. These rashes may not be itchy or oozing, and they may persist for days or weeks.
Weight loss: Healthy, active children may be finicky about eating, refusing to eat because they say they’re not
hungry or because they don’t like the food offered. Other children may overeat and gain weight. But if a child
seems fatigued, lacks an appetite and is losing rather than gaining weight, it’s a sign that her problem could
be juvenile arthritis.
Eye problems: Eye infections like conjunctivitis (pinkeye) are relatively common in children, as they easily pass bacterial infections to each other during play or at school. But persistent eye redness, pain or blurred vision may
be a sign of something more serious. Some forms of juvenile arthritis cause serious eye-related complications
such as iritis, or inflammation of the iris and uveitis, inflammation of the eye's middle layer.
While many early symptoms of juvenile arthritis could be easily mistaken for other childhood diseases or
injuries that aren't serious or long-lasting, it’s important for parents to get a proper examination and
diagnosis from their paediatrician. Juvenile arthritis includes many different diseases, but one common
thread between them is that they can have serious, even life-threatening impacts on a young child.
Diagnosis by a physician can determine the cause of the symptoms, rule out injuries or other diseases, and
suggest treatments that will ease symptoms and allow your child to return to school and resume playing
with friends and enjoying childhood.
Doctors & Support
Rheumatologist (Sydney) - Dr Davinder Singh-Grewal
Dr Davinder Singh-Grewal is a pediatric rheumatologist with over 10 years of experience in the management of children with rheumatic diseases. He completed his medical training at The University of Sydney and his
pediatric training in Sydney before undertaking a dedicated three year fellowship in Pediatric Rheumatology
at the Hospital for Sick Children in Toronto Canada has worked as a Consultant Pediatric Rheumatologist at
The Great Ormond Street Hospital in London, UK.
He is currently appointed at all three children’s hospitals in New South Wales – The Children’s Hospital at
Westmead, The Sydney Children’s Hospital at Randwick and the John Hunter Children’s Hospital in Newcastle
along with Liverpool Hospital in South Western Sydney.
Dr Singh-Grewal is a Senior Clinical Lecturer at The University of Sydney, The University of New South Wales
and The University of Western Sydney. He has completed a PhD in the field of Juvenile Arthritis and also a
Masters in Medical Science.
Dr Singh-Grewal has a strong research background with over 20 publications in peer reviewed journals and
numerous ongoing research projects in the field of pediatric rheumatology.
He is an active member of Arthritis NSW which is the peak patient group for children with arthritis and is
heavily involved with Lupus NSW and The Juvenile Dematomyositis Care to Cure Foundation which support
patients and families with affected by SLE and JDM.
Opthamolgist (Sydney) - Dr John Grigg
Training in ophthalmology was at Sydney Eye Hospital. Fellowship in glaucoma, cataract and pediatric
ophthalmology were undertaken in Australia and the UK. He held the consultant ophthalmologist position in Manchester. His sub-specialty ophthalmology practice is in glaucoma, cataract and pediatric ophthalmology.
He is conducting research in glaucoma and genetic eye disease and electrophysiology.
Dr Grigg is a senior lecturer and the Head of Discipline of Ophthalmology of the University of Sydney, a
consultant at Sydney Eye Hospital and The Children’s Hospital, Westmead. He is currently the chair of the
Royal Australian and New Zealand College of Ophthalmology (RANZCO) scientific committee.