Juvenile rheumatoid arthritis is classified as systemic

Limping may be observed in individuals with more severe JRA; however, the presence of limping also raises the possibility of trauma or another orthopedic problem. Typically, patients with JRA and their parents and/or caregivers are concerned about missing school; in contrast, when psychogenic factors predominate , patients and their parents and/or caregivers are more worried about returning to school than about missing school. Individuals with JRA may have a school history of absences, and their abilities to participate in physical education classes may reflect severity of the disease. Disease onset is either insidious or abrupt, with morning stiffness and arthralgia during the day. Juvenile rheumatoid arthritis is classified as systemic, pauciarticular, or polyarticular disease according to onset within the first 6 months. Rheumatoid factorpositive disease, similar to rheumatoid arthritis in adults, is more often found in adolescents. Polyarticular JRA can occur throughout childhood and adolescence. Systemic-onset disease can also occur in early childhood; however, it is sometimes observed in late childhood or early adolescence. Pauciarticular JRA tends to affect children in early childhood.