Juvenile Idiopathic Arthritis

Examinations and Tests

Findings from a physical examination, including the pattern and nature of joint symptoms, are important keys to the diagnosis of juvenile idiopathic arthritis (JIA). In most cases, routine lab results do not point to an obvious diagnosis of this disease. JIA is often diagnosed only after other possible causes of symptoms have been ruled out and the pain and stiffness have lasted for at least 6 weeks. The following tests are mainly done to see whether another medical condition is causing joint pain or whole-body (systemic) symptoms.

Routine examinations and tests include the following:

• Medical history and physical examination
• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR, or sed rate)
• Urinalysis
• Rapid strep test or throat culture (to test for strep throat)

The following tests are done if needed:

• Rheumatoid factor (RF), to clarify whether a child with polyarticular JIA is RF-positive or RF-negative
• Antinuclear antibody (ANA), to clarify a child's type of JIA and risk for eye disease (a positive ANA result is a marker for high eye disease risk, usually found in girls who develop pauciarticular JIA at a young age)
• X-ray
• Magnetic resonance imaging (MRI), which may reveal early joint damage
• Human lymphocyte antigen or HLA-B27 genetic test, which may help distinguish JIA from other types of arthritis that affect children, such as ankylosing spondylitis

Early Detection

There are no standard screening tests that are used to identify children who may develop juvenile idiopathic arthritis (JIA).

Early eye disease detection

Slit lamp eye examinations are necessary for all children with juvenile idiopathic arthritis to test for possible eye problems, such as uveitis. This test may be repeated often during the course of the condition because the inflammatory eye disease associated with JIA generally has no symptoms and can lead to a permanent decrease in vision or blindness.

Inflammatory eye disease risk is not related to how severe a child's other JIA symptoms are. In fact, children at greatest risk are girls who develop mild pauciarticular disease (oligoarthritis) during their early childhood years and have developed high levels of antinuclear antibodies (ANAs).

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: August 30, 2006
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Ross E. Petty, MD, PhD, FRCPC - Pediatric Rheumatology
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