Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
The symptoms of juvenile rheumatoid arthritis vary greatly from child to child. They may be very mild, very severe, or anything in between, and they may change over time, sometimes overnight. Fluctuations, whereby the symptoms get worse (flare) and then get better or go away completely (remission), are fairly typical of JRA.
Joint pain, warmth, stiffness, and swelling: These are the most common symptoms of JRA, but many children do not recognize, or do not report, pain. Stiffness and swelling are likely to be more severe in the morning.
Loss of joint function: Pain, swelling, and stiffness may impair joint function and reduce range of motion. Some children are able to compensate in other ways and display little, if any, disability. Severe limitations in motion lead to weakness and decreased physical function.
Limp: A limp may indicate a particularly severe case of JRA, although it also may be due to other problems that have nothing to do with arthritis, such as an injury. In JRA, a limp often signals knee involvement.
Joint deformity: The joints may grow in an abnormal, asymmetrical way, causing deformities of the extremity involved.
Eye irritation, pain, and redness: These symptoms are signs of eye inflammation. The eyes may be sensitive to light. In many children with JRA, however, eye inflammation has no symptoms. If the inflammation is very severe and not reversed, it can cause loss of vision. The most common types of eye inflammation in JRA are uveitis and iritis. The names refer to the part of the eye that is inflamed, the uvea and iris, respectively.
Recurrent fevers: Fever is high and comes and goes with no apparent cause. Fever may "spike" (go high) as often as several times in one day.
Rash: A light rash may come and go without explanation.
Myalgia (muscle aches): This is similar to that achy feeling that comes with the flu. It usually affects muscles throughout the whole body, not just one part.
Lymph node swelling: This is sometimes called "swollen glands," but the lymph nodes are not glands. They are small nodules of tissue that work as part of the immune system to help remove certain types of dead cells. Normally, lymph nodes are very small and cannot be felt through the skin. When swollen, they can be felt and often are tender to the touch. Lymph nodes are spread throughout the body, but swollen lymph nodes are noticed most often in the neck and under the jaw, above the collarbone, in the armpits, or in the groin.
Weight loss: This is common in children with JRA. It may be due to the child's simply not feeling like eating. Weight loss with diarrhea suggests possible inflammation of the digestive tract.
Growth problems: Children with JRA often grow more slowly than average. Growth may be unusually fast or slow in an affected joint, causing one arm or leg to be longer than the other. General growth abnormalities may be related to having a chronic inflammatory condition such as JRA or to the treatment, especially glucocorticoids (for