Pauciarticular juvenile rheumatoid arthritis falls into 2 distinct categories. In 1 group, involving females between the ages of 1- 4 years, onset of the joint involvement occurs in the knees, ankles, or elbows. The small joints of the hands are spared. Painless swelling of the involved joint is common. A positive speckled antinuclear antibody is frequently found.
Eye disease can be present without eye pain, redness, or other clinical signs.
Slit lamp examination is imperative in these children. A chronic, non- granulomatous inflammation of the uveal tract involves predominantly the anterior segments of the eye, iris, and ciliary body. The earliest signs of uveitis are those of cellular exudate and an increased number of inflammatory cells in the anterior chamber of the eye. Inadequately controlled inflammation will lead to progressive damage, with the development of posterior synechiae that arise from adherence of the iris to the anterior surface of the lens and result in an irregular or poorly reactive pupil. The second form of pauciarticular arthritis occurs in predominantly in boys 8 years of age or older.