Juvenile Idiopathic Arthritis

Arthritis in Children

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Children with juvenile arthritis benefit from early diagnosis and ongoing medical care to control their condition and prevent growth problems, joint damage, and loss of mobility. Duke’s pediatric rheumatologists have extensive experience managing juvenile arthritis and working with the latest treatment advances. We’ve helped thousands of children and teens get their arthritis under control and live active lives. 

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Comprehensive Juvenile Arthritis Care

Early diagnosis of juvenile arthritis can preserve joint function -- and possibly put the disease into remission. The first step is to identify the type of arthritis your child has. Juvenile idiopathic arthritis (JIA), previously called juvenile rheumatoid arthritis, includes six types of arthritis. Each subtype affects the body differently, causing varying symptoms and complications.

Oligoarticular Juvenile Arthritis
The most common type of juvenile arthritis. It causes inflammation in four or fewer joints, usually affecting the knees, ankles, or elbows. Children with this subtype have the highest risk of developing a serious, chronic inflammatory eye condition called pediatric uveitis.

Polyarticular Juvenile Arthritis
Affects five or more joints. It is more likely to cause inflammation in smaller joints, including the hands, feet, or jaw, but it can also strike weight-bearing joints such as the knees, ankles, and hips.

Systemic Juvenile Arthritis
Affects far fewer children but can be much more serious. Along with joint swelling and inflammation, it can also cause inflammation of the heart, lungs, and other organs. Early symptoms may include an ongoing fever and skin rash.

Juvenile Psoriatic Arthritis
Causes joint inflammation, especially in the fingers and toes, and a skin disease called psoriasis.

Enthesitis-related Juvenile Arthritis
Affects joints and the tissues that attach to them (tendons and ligaments). It commonly strikes the hips, knees, or feet in children.

Undifferentiated Arthritis
Refers to childhood arthritis that does not fit into any one category. Symptoms may span two or more subtypes.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.


Physical Exam

Your doctor will carefully examine your child’s joints for signs of inflammation, including swelling and redness. He or she will also test joint range of motion.

Blood and Urine Tests

Can detect certain proteins and other chemicals that indicate high levels of inflammation, help classify what subtype of juvenile arthritis your child has, and look for additional signs of the disease.  

CT, MRI, Ultrasound

Imaging tests help your doctor rule out other reasons for joint swelling and pain such as bone fractures, tumors, and infections. They can also identify the extent of joint damage.

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In general, juvenile arthritis treatments are designed to relieve inflammation, control pain and other symptoms, and prevent long-term complications like joint damage. Early, aggressive treatment may put your child’s arthritis into remission. 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Over-the-counter or prescription-strength NSAIDS, including ibuprofen and naproxen, help relieve joint pain, swelling, and stiffness.


Strong steroid drugs in the form of injections (shots) and pills can suppress the entire immune system. Our doctors prefer to use steroid joint injections because they work quickly without serious side effects. Oral medications such as prednisone may be used in certain situations, but only for a brief time and at the lowest dose possible due to the risk of long-term side effects in growing children. 

Disease-Modifying Anti-Rheumatic Drugs

These medicines, including methotrexate, are sometimes called steroid-sparing drugs. They offer many of the benefits of corticosteroids with fewer side effects but can take longer to work. Over time, they help slow or stop the progression of JIA.


This is a newer class of disease-modifying drugs made from living organisms. Instead of suppressing the entire immune system, they target specific parts of it. Certain biologics are increasingly being used to treat juvenile arthritis. Which biologic therapy is used depends on the underlying diagnosis.

Physical and Occupational Therapy

Depending on the extent of your child’s symptoms, he or she may need physical or occupational therapy to strengthen muscles, improve mobility, or learn more efficient ways of performing everyday tasks.

Why Choose Duke

Extensive Experience
Duke offers children with arthritis a level of care that’s not widely available. Our five fellowship-trained pediatric rheumatologists are familiar with all forms of juvenile arthritis and have experience managing even the most challenging complications.

A Team of Specialists
Our pediatric rheumatologists partner with other Duke Children’s specialists to diagnose and manage complications associated with juvenile arthritis. This includes our collaboration with pediatric ophthalmologists. Because uveitis is one of the most common complications of juvenile arthritis, our pediatric rheumatologists refer all children with arthritis for regular eye exams. Early detection of uveitis is key to preventing serious complications, including partial or total vision loss.

Access to Clinical Trials
We offer clinical trials to eligible patients who are interested in trying new treatments for juvenile arthritis. For example, Duke pediatric rheumatologists are investigating the best time to introduce biologic medications into a child’s treatment plan and whether a child’s genetics determine how they’ll respond to methotrexate treatment. We are also studying why some children achieve disease remission before reaching adulthood, while others will enter adulthood with ongoing arthritis despite treatment.

Nationwide Effort to Improve Treatment
Together with the Childhood Arthritis and Rheumatology Research Alliance, our pediatric rheumatologists helped develop a national “observational registry” for juvenile arthritis. It’s a database that follows thousands of enrolled children over time, to see how their arthritis has progressed or slowed following various treatments and whether those treatments have caused side effects.

We Understand the Challenges
If your child’s symptoms or therapies are interfering with school, our dedicated social worker can help. For example, we can arrange accommodations to help your child keep up with their schoolwork despite the need to miss school for infusions, doctor visits, physical therapy visits, and eye exams. Occasionally, children will need to go to school later in the day until their disease is well controlled, due to pain and stiffness in the morning.

Transition to Adult Care
When your child is ready to begin seeing an adult rheumatologist, he or she will meet with their pediatric specialist and their new adult specialist at the same time. This helps ensure there is no interruption in care, which could lead to a disease flare-up.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

This page was medically reviewed on 11/21/2019 by