Juvenile Arthritis: Diagnosis and Treatment Options for Your Child

First published July 2017
Updated October 2026

When I tell people I'm a pediatric rheumatologist — a doctor who takes care of children with arthritis and autoimmune disorders — nearly everyone responds, "I didn't know kids could get arthritis."

They can and do. Joint swelling and joint complaints are common reasons children are referred to specialists. Arthritis means having either joint swelling or the loss of a joint's normal range of motion along with pain when it moves. Pain alone in a joint does not mean a child has arthritis.

In childhood, arthritis is often a temporary reaction to the body fighting an infection. The immune system can sometimes mistake the proteins in our own joints for parts of a virus or bacteria. While the body fights the infection, there can be a short period when that inflammation is accidentally directed at the joints. Usually, as the infection resolves, this kind of arthritis goes away too.

However, some children develop a form of arthritis that has no clear cause and, instead of clearing up after a few weeks, continues to affect the same — or more — joints. When arthritis has no identifiable cause, begins before age 16, and lasts longer than six weeks, it is called Juvenile Idiopathic Arthritis (JIA). "Idiopathic" means there is no clear cause. JIA is the most common chronic rheumatic disease of childhood, affecting roughly 1 in 1,000 children. 

What JIA is Not

JIA should not be confused with osteoarthritis, the "wear-and-tear" arthritis many older adults have. Osteoarthritis comes from the gradual loss of the smooth protective cartilage covering the bones at a joint, which allows the bones to grind on one another. JIA is an immune-driven inflammation, not wear and tear.

JIA is also not the same as adult rheumatoid arthritis. While there is some overlap with the adult disease, JIA is considered its own condition. In fact, JIA is really a group of related conditions that all share the feature of arthritis.

Types of Juvenile Idiopathic Arthritis

• Oligoarticular — Four or fewer joints are affected. This is more common in girls and often begins in early childhood around age two or three years. These children have a risk of silent eye inflammation (uveitis) and need eye screenings multiple times a year.
• Polyarticular — Five or more joints are affected. This is also more common in girls and can begin in early childhood or in the teenage years. If a rheumatoid factor is identified it could mean a more severe form of arthritis - but not always.
• Enthesitis-Related Arthritis — An enthesis is where a tendon or ligament attaches to bone. There can be pain along tendons and a risk for arthritis of the back and pelvis (spondyloarthritis). It is more common in boys and usually develops in adolescence.
• Psoriatic Arthritis — Arthritis in children who have the skin condition psoriasis, or who have a close relative with psoriasis. Clues can include a swollen "sausage" finger or toe and nail changes. It can occur at any point in childhood.
• Systemic JIA — This form is quite different from the others. Along with arthritis, children have high, spiking daily fevers and a rash, and may feel generally unwell. It affects boys and girls equally and can occur at any age in childhood. 
• Undifferentiated JIA — Arthritis that does not fit neatly into one category, or that fits more than one.

How Is JIA Diagnosed?

JIA is diagnosed based on a careful history and physical examination by a pediatrician or specialist, after other causes have been ruled out. There is no single blood test or x-ray that can confirm JIA. Blood tests can still be useful in measuring the amount of inflammation in the body, helping rule out other conditions, and identifying children at higher risk for complications such as uveitis (inflammation of the eye). Normal inflammation levels do not rule out JIA, and common antibody tests can be positive in healthy children, so these labs are used to support — not make — the diagnosis. X-rays and other imaging are mainly used to make sure a fracture or tumor is not causing the swelling.

How Is JIA Treated?

The overall goal is to reduce joint inflammation quickly and keep it controlled — an approach called "treat to target," aiming for little or no disease activity (remission) to protect the joints from long-term damage. Most children do very well.

Treatment is tailored to the type of JIA and how many joints are involved, and may include:

• Anti-inflammatory medicines (NSAIDs), like ibuprofen and naproxen, to help with pain and stiffness.
• Steroid injections directly into the affected joint(s), especially when only a few joints are involved.
• Disease-modifying medications (DMARDs), such as methotrexate, which can be taken by mouth or as an injection at home.
• Biologic medications, given as home injections or as infusions at the hospital or infusion center, which target the specific parts of the immune system driving the inflammation. 

Oral steroids by mouth are now used sparingly and as a short-term "bridge" while longer-term medications take effect. Alongside medication, children with JIA benefit from physical and occupational therapy, staying physically active, and a well-balanced diet with enough vitamin D and calcium to support healthy bones.

Should My Child Be Seen by a Rheumatologist?

JIA usually develops gradually. Consider having your child evaluated if you notice:

• Unexplained swelling in one or more joints that persists over several weeks without improvement.
• Limping, or difficulty using the fingers or wrists.
• Stiffness when moving, especially first thing in the morning or after naps.
• Daily, unexplained fevers accompanied with rashes that come and go with the fevers.

If any of these are present, start with your child's pediatrician, who can refer you to a pediatric rheumatologist if needed. Early evaluation matters: there is a "window of opportunity" in which starting treatment promptly can change the course of the disease and prevent lasting joint damage. If there is strong concern for JIA, an eye doctor may also be involved early to check for uveitis.