Jennifer Freeman, MD
Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Sep 22, 2018 4 min read

JRA Diagnosis: How Is Juvenile Rheumatoid Arthritis Diagnosed?

Juvenile rheumatoid arthritis can be just as difficult (if not more so) to diagnose in children as it is in adults. Many of the early symptoms can be mistaken for other conditions, which causes a delay in narrowing down the different diagnosis possibilities.

children

There is, however, a precise series of steps that doctors go through when diagnosing children with juvenile rheumatoid arthritis. These steps combine aspects of the physical examination and family (as well as personal) medical history with blood and imaging test results.

Early Symptoms

When diagnosing a child with juvenile rheumatoid arthritis, the symptoms must be consistent with rheumatoid arthritis. Other tests and examinations can be done to further help support the diagnosis, however, doctors look for the distinct early warning signs. These early signs and symptoms include:

  • Persistent joint swelling
  • Consistent complaints of joint pain
  • Joint pain primarily in hands, wrists and knees
  • Appearance of skin rashes
  • Swollen lymph nodes
  • Development of a limp
  • Loss of motor skill function
  • Eye dryness
  • Eye inflammation

Above are the most common early signs and symptoms that lean doctors toward diagnosing juvenile rheumatoid arthritis. However, a child may not have all of these symptoms or they may not happen all at once.

Diagnosis

In order to be diagnosed with juvenile rheumatoid arthritis, a child must have started showing symptoms before the age of 16 or 17 years old. Children as young as two years old can be diagnosed with juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis is difficult to diagnose because many children do not complain of the primary symptom — pain. Younger children sometimes don’t know what is and isn’t normal, and as a result, they might let their condition go undetected and ignored.

It’s also possible that many physical signs of rheumatoid arthritis may not be obvious at first, like joint swelling. Signs like fatigue and fever can easily be mistaken for other conditions, especially in children who are more susceptible to infections and other illnesses.

Juvenile rheumatoid arthritis is diagnosed through a combination of assessing symptoms, physical examination, blood tests, imaging scans as well as analyzing family medical histories. Primarily though, the patient must exhibit clear signs of joint pain and swelling consistent with rheumatoid arthritis in order to confirm a diagnosis.

The diagnosis may also be called juvenile idiopathic arthritis and further sub-types could include polyarticular, oligoarticular or systemic onset juvenile rheumatoid arthritis.

Physical Exam

First, doctors do a full physical exam to ensure that symptoms align with juvenile rheumatoid arthritis. They look for symptoms like:

  • Limping
  • Not using a certain arm or leg
  • Morning stiffness
  • Ongoing fever that comes and goes regularly
  • Reduced physical activity
  • Joint swelling consistent for at least 6 weeks
  • Decrease in motor skills such as the ability to hold a fork or pencil
  • Consistent fever
  • Chronic fatigue
  • Malaise or feelings of being unwell

If these symptoms are found, then doctors move on to conducting blood tests and imaging scans to help further diagnose the condition.

Blood Tests

There are a number of different blood tests that may be conducted to help identify juvenile rheumatoid arthritis. The blood tests doctors use to help diagnose juvenile rheumatoid arthritis include:

  • Rheumatoid factor (RF)
  • Anti-Cyclic Citrullinated Peptide (CCP)
  • Erythrocyte Sedimentation Rate (ESR)
  • C-Reactive Protein (CRP)
  • Antinuclear Antibody (ANA)

Rheumatoid Factor (RF)

One of the first tests that is done when rheumatoid arthritis is suspected is the RF blood test. RF is the antibody that can lead to rheumatoid arthritis symptoms. If a child tests positive it can lead to a positive juvenile rheumatoid arthritis diagnosis although it’s not always a definite indicator.

Anti-Cyclic Citrullinated Peptide (CCP)

Similar to the RF, if a child shows the presence of anti-CCP antibodies in their blood, then this can result in a rheumatoid arthritis diagnosis. Today, this is used as a more sensitive test result than RF in helping diagnose rheumatoid arthritis in patients.

Erythrocyte Sedimentation Rate (ESR)

ESR tests are used to measure inflammation levels in patients. It is considered a non-specific test for rheumatoid arthritis. If an ESR test indicates high levels of inflammation, this can support a juvenile rheumatoid arthritis diagnosis.

C-Reactive Protein (CRP)

Like the ESR test, the CRP test measures levels of inflammation in potential juvenile rheumatoid arthritis patients. It is also a non-specific test for rheumatoid arthritis. Positive test results can help achieve a diagnosis.

Antinuclear Antibody (ANA)

Several autoimmune disorders, including juvenile rheumatoid arthritis, are the result of an antibody protein called the antinuclear antibody (ANA). Testing positive for ANA could lead to a juvenile rheumatoid arthritis diagnosis.

Imaging Scans

In conjunction with blood tests, imaging scans can be conducted in order to eliminate the potential of other conditions exhibiting similar symptoms. Imaging scans will look for fractures, infections, and tumors. Scans will also be able to identify any early signs of bone or cartilage damage and erosion in the joints.

Family History

To ensure a complete juvenile rheumatoid arthritis diagnosis, physicians will look at family history. Juvenile rheumatoid arthritis is rare, and so it is unlikely that multiple family members will be diagnosed with it.

A family history of any sort of autoimmune disorder could potentially increase the likelihood of developing juvenile rheumatoid arthritis. If the child has a family member with an autoimmune disorder it could further support a diagnosis. It could indicate the child could have also developed an autoimmune disorder such as juvenile rheumatoid arthritis.

Other Conditions

Sometimes juvenile rheumatoid arthritis can display the same symptoms as other conditions. Doctors may decide to do further testing to rule out other potential conditions. Some of these conditions are:

  • Juvenile dermatomyositis
  • Juvenile psoriatic arthritis
  • Systemic lupus erythematosus
  • Still’s disease
  • Lyme disease
  • Lupus
  • Viral or bacterial infections
  • Cancer

Like in adults, symptoms of rheumatoid arthritis are different for each child. Some cases of juvenile rheumatoid arthritis can be much more severe than others. Some of the severe cases of juvenile rheumatoid arthritis affect a child’s growth where joints grow slower or unevenly. This can result in one limb being longer than the other.

After a diagnosis is confirmed, it’s important for children and their families to work with a pediatric rheumatologist or another similar specialist on an ongoing basis. Monitoring symptoms and providing early preventative treatment can ensure children lead healthy and full lives.