The Best Way to Diagnose Juvenile Arthritis

Due to the high percentage of false-positives in lab tests, review urges physical examination to be the primary method of diagnosis of JIA.

According to a new review, published in the Journal of American Academy of Orthopaedic Surgeons, a physical examination and patient history are the most important tools at the disposal of physicians when it comes to screening children for juvenile arthritis.

Juvenile arthritis (JA) was once thought to be a rare childhood disease, but research has shown that it is prevalent among minors, and generally manifests itself between the ages of six months old and sixteen years old. The most common form of JA is JIA, or juvenile idiopathic arthritis (formerly called juvenile rheumatoid arthritis).

Currently, JIA affects nearly 300,000 children in the United States.

The cause for the disease in children is not known, but symptoms include: joint stiffness in the morning (which approves later in the day), painful and swelling joints, visible limping/limitations in range of motion, weight loss, high fever and a light rash, fatigue, irritability, and/or red eyes and blurred vision.

“To establish a diagnosis of juvenile idiopathic arthritis is a matter of pattern recognition,” said Marilynn Punaro, MD. Punaro is the author of the review, and is also a pediatric rheumatologist at Texas Scottish Rite Hospital for Children and University of Texas Southwestern Medical Center.

While lab tests may be important to the diagnosis process, Punaro stated that they should not be the only factor relied upon for diagnosis.

According to Punaro, “there is no lab test that can conclusively diagnose rheumatic disease—you have to rule out other common diagnoses. That is why a full physical exam is important, as well as a detailed patient history that will reveal other symptoms.”

The review made several suggestions and observations concerning the diagnosis of JIA. If JIA is suspected, Punaro said in the review, the orthopaedic surgeon should always conduct an assessment of every peripheral joint, and not just the joints that the child reports having issues with. “If the patient has one swollen joint, the other joints should be examined because the diagnoses could be very different based on what is found in that exam,” she said.

The purpose of JA treatment is to reduce swelling of the joints, maintain full movement of the joints affected, and to relieve pain for the child. Depending on the severity of the case, medication and/or physical therapy may be necessary, or, in rare cases, surgery.

Happily, however, recent drug treatment clinical trials along with the redefined guidelines of rheumatoid arthritis have shown that remission is a realistic goal for most patients. Early detection, however, is critical to the well-being of the child.

"It is important to try and diagnose JIA early so treatment can begin," Punaro said. "If left untreated for months or years, there is a likelihood of long-term disability, growth problems or deformity. The disease can cause joint damage that is irreversible. The good news, though, is that when we do diagnose JIA, we have many excellent treatments available."