Evaluation of rheumatic causes underlying childhood-onset arthritis

Childhood-onset arthritis may result from various rheumatic diseases. This study aimed to systematically evaluate their distribution and characteristics in a large pediatric cohort.

We retrospectively analyzed all pediatric patients who presented with arthritis to the pediatric rheumatology clinic between January 2000 and January 2023.

A total of 1713 pediatric patients who presented with arthritis were included in this study (median age at diagnosis: 6.8 years; F/M = 1.2). Most of the patients (n = 859, 50.1%) had juvenile idiopathic arthritis (JIA) (especially oligoarticular JIA). Patients with familial Mediterranean fever, comprising 277 individuals (16.2%) presented with arthritis. The majority of them (n = 203, 73.3%) had short-lasting recurrent oligoarthritis (mostly monoarthritis) attacks. While arthritis was observed in 236 (13.8%) patients with vasculitis, immunoglobulin A vasculitis was the most common cause among them (n = 166, 70.3%). Most of the vasculitis patients had oligoarthritis (n = 221, 93.6%). Reactive arthritis was present in 147 patients (8.6%, mostly monoarthritis). Acute rheumatic fever was another cause of arthritis (4.7%, mostly polyarticular and migratory). Among autoimmune diseases (mostly systemic lupus erythematosus), arthritis was detected in 82 patients (4.8%, oligoarthritis or polyarthritis).

In our study, we focused on the rheumatic etiologies underlying childhood arthritis. Given the heterogeneity of etiologies, clinical evaluation should be comprehensive, considering systemic features beyond joint involvement.