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.
It is important to remember that many conditions other than juvenile rheumatoid arthritis can cause joint pain, stiffness, and swelling.
Examples are infections with bacteria or viruses, injury (such as a sprain or fracture), systemic lupus erythematosus, inflammatory bowel disease, Lyme disease, and certain kinds of cancer.
Other symptoms of JRA are similarly not specific, meaning that they can be caused by many different conditions. Fever, for example, is a very common symptom of infection.
A child who has joint symptoms needs a thorough evaluation by a qualified medical professional. This evaluation will focus on consideration of many conditions and thus arriving at a specific diagnosis.
In some children, the symptoms strongly suggest some type of arthritis. In others, the symptoms and signs are more subtle and require careful investigation by the health care provider. Often, a specialist such as a pediatric rheumatologist is consulted to help with the diagnosis
as well as treatment plan.
The medical interview is a crucial part of making a diagnosis. You will be asked about the following information. It is important that you answer as completely as possible, as this information may help your child.
Your child's symptoms and behavior
The child's other medical problems, injuries, and accidents, either recent or in the past
His or her vaccinations, medications, and allergies
His or her activities, such as sports and games
Family medical history (medical problems in the brothers and sisters, mother and father, and their families)
The family's habits and lifestyle
The child's exposures to pets and other animals
Recent travel or time spent outdoors, such as camping, hiking, or on a farm
A detailed physical examination is another critical tool in the evaluation. The examination will include observing, touching, and moving the joints. Muscle strength and flexibility also will be checked. The person conducting the examination looks specifically for evidence of pain, stiffness, swelling, or deformity. The physical examination will cover all systems of the body, with special focus on systems often affected by JRA, such as the eyes, the skin, the heart, and the digestive tract.
There is no lab test that definitely confirms that a child has JRA. The diagnosis is made from a combination of the information gained from the medical interview and physical examination, from a number of different lab tests, and, in some cases, from
X-rays and related tests. Because the symptoms must persist at least
six weeks to be considered JRA, these lab tests may need to be repeated to confirm the diagnosis. After JRA is diagnosed, the tests are done every so often to check disease activity and the success of treatment. All of these are blood tests unless stated otherwise.
Erythrocyte sedimentation rate (ESR): ESR is a "nonspecific" marker. It does not point specifically to JRA but indicates active inflammation in the body. It is almost always elevated in children with systemic JRA. It usually is elevated in children with polyarticular disease but is often normal in those with pauciarticular disease.
Complete blood cell count (CBC): This test measures the amounts of each type of blood cell in a sample of blood. It also indicates the level of hemoglobin, the protein in blood that carries oxygen around the body. A low level of hemoglobin, called anemia, is common in children with JRA. This test highlights abnormalities in the numbers of various kinds of white blood cells (part of the immune system) or of platelets (which help blood clot). It can be used to distinguish JRA from other conditions that might have similar symptoms. The white blood cell count and platelet count are usually normal in people with JRA.
Antinuclear antibody (ANA): Antinuclear antibody is one of the antibodies that the body may produce in certain autoimmune diseases (called autoantibodies). As many as 25% of children with JRA have a positive ANA result. A positive ANA result is most common in children with pauciarticular disease. It is uncommon in children with systemic JRA. It is linked to an increased risk of eye involvement (uveitis). ANA is also more likely to be positive in conditions related to JRA (such as SLE or scleroderma) than in JRA. It is often used to rule out these conditions in a person with arthritis symptoms. Very high levels of ANA may increase the risk that the disease will progress to adult-type SLE.
Rheumatoid factor (RF): Rheumatoid factor is actually a group of autoantibodies that occur in some people with RA, JRA, and related conditions. It is most often positive in children with polyarticular JRA and is rarely positive in children with systemic JRA. It is most often used to help determine which type of JRA a child has. Adolescents are more likely to have a positive RF result than younger children. In fact, many consider a positive RF result a sign of JRA progressing to adult-type RA.