When should I consider referring a child with suspected JIA to a specialist for further evaluation?

Consider referring a child with suspected juvenile idiopathic arthritis (JIA) to a specialist for further evaluation if:

• There is redness, swelling, or stiffness of the joint or limb, which may indicate inflammatory joint disease.
• The child has limp and stiffness that is worse in the morning, suggestive of inflammatory joint disease.
• The cause of the limp or joint symptoms cannot be managed in primary care or there is uncertainty about the cause.
• The child presents with a limp on multiple occasions.
• There are red flags such as fever, unexplained rash or bruising, weight loss, anorexia, night sweats, or fatigue that may indicate systemic involvement.

Referral urgency depends on clinical judgement, but urgent specialist assessment is warranted if there are signs of serious pathology or inflammatory joint disease.

Do not delay referral based on normal blood tests or pending results, as early specialist assessment is important for diagnosis and management.

In primary care, consider offering a nonsteroidal anti-inflammatory drug (NSAID) at the lowest effective dose until specialist assessment is available, but do not prescribe glucocorticoids before specialist review as they may mask key clinical features.

These recommendations are based on NICE CKS guidelines on childhood limp and inflammatory joint disease in children ²,³,⁴.