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Despite extensive research the cause of this condition remains unclear. In 30% only a single joint, usually the knee, is involved; in 50% multiple joints are involved. The systemic symptoms of JRA may precede the onset of overt arthritis for a variable periods of time ranging from months to years. Chills are frequent at the time of the fever though rigors rarely occur.
These children often appear quite ill while febrile but surprisingly well during the rest of the day. These fevers may respond poorly to anti-pyretics (including aspirin). In some instances, the fever responds only to steroid therapy. Laboratory tests are not helpful in confirming the diagnosis of Still's Disease. Both the ANA and Rheumatoid Factor are usually negative and there is no association with HLA-B27. Antinuclear antibody may be positive, if so, it is often in a speckled pattern. The differential diagnosis includes acute and chronic infection, malignancy, Kawasaki's disease, inflammatory bowel disease, rheumatic fever, and SLE. Chronic uveitis is a perplexing complication of JRA which occurs most commonly in young girls with oligoarthritis and ANA seropositivity. Around 1/4 of patients with oligoarthritis develop uveitis.
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