The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. JA commonly affects the knees and the joints in the hands and feet. One of the earliest signs of JA may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic JA have a high fever and a skin rash. The rash and fever may appear and disappear very quickly. Systemic arthritis also may cause the lymph nodes located in the neck and other parts of the body to swell. In some cases (fewer than half), internal organs including the heart and (very rarely) the lungs, may be involved.
Eye inflammation is a potentially severe complication that commonly occurs in children with oligoarthritis but can also be seen in other types of JA. All children with JA need to have regular eye exams, including a special exam called a slit lamp exam. Eye diseases such as iritis or uveitis can be present at the beginning of arthritis but often develop some time after a child first develops JA. Very commonly, JA-associated eye inflammation does not cause any symptoms and is found only by performing eye exams.
Typically, there are periods when the symptoms of JA are better or disappear (remissions) and times when symptoms “flare,” or get worse. JA is different in each child; some may have just one or two flares and never have symptoms again, while others experience many flares or even have symptoms that never go away.
Some children with JA have growth problems. Depending on the severity of the disease and the joints involved, bone growth at the affected joints may be too fast or too slow, causing one leg or arm to be longer than the other. Overall growth also may be slowed. Doctors are exploring the use of growth hormone to treat this problem. JA may also cause joints to grow unevenly.