Systemic onset juvenile rheumatoid arthritis (JRA)1 often follows a respiratory infection and has intermittent and persistent fever greater than 103 F (39 C) accompanied by classic rheumatoid rash. These children usually have multiple joint involvement (lasting more than six continuous weeks with the cervical spine often affected). Joint findings include swelling with thickening of the synovium with or without effusion, tenderness, pain on motion, and later limitation of motion (LOM) due to contracture. Early LOM can be a prominent and helpful finding. Girls are more commonly affected than boys (2/1) and onset can be at any age of childhood. Pericarditis, when present, almost always occurs in this group with hepatomegaly, splenomegaly, and lymphadenopathy.

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