Your 2-year-old son is toddling around the living room after breakfast when you notice his left knee appears swollen and he is walking in an unusual way. The cause could be a condition most people associate only with adults: arthritis.

Around 300,000 children have juvenile arthritis (JA), according to the American College of Rheumatology. Researchers are trying to pinpoint the causes of JA, but it’s believed the disease occurs because something goes wrong with the immune system. Children with immune system abnormalities or a family history of arthritis may be more likely to develop JA.

Spotting the Signs
JA, which often occurs during toddlerhood, may be difficult to diagnose. The key symptoms: joints that are swollen, stiff, abnormally angled—and don’t hurt.

“JA isn’t actually a very painful disease, at least in the beginning,” says Andrew White, MD, a Washington University pediatric rheumatologist and director of rheumatology at St. Louis Children’s Hospital. “Pay attention to morning stiffness and swelling that gets better by bedtime. Typically, the more the child uses an arthritic joint, the more limber it gets, so symptoms may lessen throughout the day.”

If you notice signs of JA, consult your child’s pediatrician, who will refer you to a pediatric rheumatologist if it looks like the disease might be present. The rheumatologist will likely order blood work to rule out other problems and take note of your child’s history—symptoms typically must be present for at least six weeks in a row to diagnose JA. Typical treatments include cortisone injections if few joints are affected and medication if many joints are involved.

“Parents often ask if they’ll have to install wheelchair ramps at home because they think JA will hinder their children’s ability to walk,” Dr. White says. “That won’t be necessary in the vast majority of cases. JA is a treatable illness, and children who have it stand a reasonable chance of it going away completely.”

If your pediatrician thinks your child might have JA, the pediatric rheumatologists at St. Louis Children’s Hospital can help. Learn more about our rheumatology services.


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