Q: My 16 years old was a perfectly healthy kid. Three months back, he got a swollen thumb. He also started having pain in thumb and other joints and developed swelling in elbows, knees, wrists etc. He started having high temperatures. The doctor diagnosed him with juvenile rheumatic arthritis and treated him for the same for 3-4 weeks. He did not develop any fever after undergoing the treatment but suddenly his face and neck glands got swollen. Even his stomach became very hard. Some tests revealed that he still had traces of jaundice, and that he has excess fluid in his stomach, liver and other parts of the body. His blood count is also very low. Is my cousin still suffering from juvenile rheumatic arthritis?

A:The diagnosis of juvenile idiopathic arthritis/juvenile rheumatoid arthritis is a diagnosis of exclusion. There are many causes of joints being swollen such as infection, connective tissue diseases, inflammation of the blood vessels called vasculitis and some times cancers as well. Only one form of childhood arthritis presents with fever: Systemic onset arthritis. Your cousin may have this form of arthritis or indeed other serious disease that can have arthritis. Usually children with juvenile rheumatoid arthritis don’t have severe joint pains. This is a serious concern and he needs to be urgently evaluated by a paediatric rheumatologist as soon as possible.