Which physical findings suggest systemic-onset juvenile idiopathic arthritis (JIA)?

Updated: Jul 25, 2019
  • Author: David D Sherry, MD; Chief Editor: Lawrence K Jung, MD  more...
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Physical examination findings include the following:

  • The child appears systemically ill

  • Arthralgia is often present

  • The child may have generalized myalgia

  • Evanescent, salmon-pink, macular rash (often linear) is found, predominantly on the trunk and the extremities; this rash, seen in the image below, is associated with fever spikes

    Systemic juvenile idiopathic arthritis (JIA) rash. Systemic juvenile idiopathic arthritis (JIA) rash.
  • Hepatosplenomegaly is often present

  • Lymphadenopathy is sometimes present, especially the axillary lymph nodes

  • Muscle tenderness to palpation may be observed

  • Serositis, including pleural and pericardial effusions, may be present, as is noted in the image below

    Child with pericardial effusion due to systemic on Child with pericardial effusion due to systemic onset juvenile idiopathic arthritis (JIA).
  • Chest pain or shortness of breath may be a sign of pericarditis or pleuritis

  • Friction rub may occur in pericarditis but can be absent with a large pericardial effusion

  • S3, basilar rales, and hepatomegaly suggestive of heart failure may rarely be observed when myocarditis occurs in individuals with systemic-onset JIA

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