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Background Juvenile idiopathic arthritis (JIA) is an heterogeneous group of autoimmune diseases considered as the main cause of chronic arthritis among children and teenagers. This group of children is thought to be more vulnerable because of chronic inflammation and long-term immunosuppressive therapy. Passive smoking, which is a major health problem, is likely to be particularly harmful for these children whose immunity is already compromised by their disease. The aim of our study was to assess the effect of parental smoking on disease activity in children with JIA Methods A monocentric cross-sectional study of patients with JIA according to the criteria of the International League Against Rheumatism (ILAR) was conducted in the rheumatology department of Kassab Institute. The following clinical and biological data were collected: sex, age, disease duration, BASDAI activity score, functional impairment assessed by the BASFI score, biological inflammation assessed by the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). All parents were contacted and smoking data were recorded: parent smoking, pack-years history, smoking in an indoor or outdoor space, impact of passive smoking on disease activity. We considered any child with at least one smoking parent and living in the same house to be exposed to parental passive smoking. Patients were divided into two groups: group 1 (G1) including patients who are not exposed to parental smoking and group 2 (G2) including patients exposed to smoking by one or both parents. Data were analyzed using SPSS (Statistical Package for the Social Sciences) version 24 software. The significance level was set at a p-value < 0.05. Results Twenty-three patients were included: 15 girls and 8 boys. Sex ratio M/F was 0.53. The mean age was 16.5 + 8.1 years [8–40]. The mean disease duration was 4.9 + 4.9 years [0.15]. The mean ESR was 21.5 + 27.1 mm and the mean CRP was 4.7 + 7.1 mg/l. Nine patients had coxitis, including 4 who were exposed to passive smoking. Passive smoking noted in 11 patients (47.8%), including 6 boys and 5 girls. In 63.6% of the cases, this exposure occurred indoor in the family home. The number of cigarettes smoked per day was 11.7 + 8.4 [1,20]. Among the exposed patients, 36.4% considered that this exposure was an exacerbating factor of their disease. Clinical and biological data were comparable between the 2 groups as shown in table 1. Conclusion Although the adverse effect of maternal smoking during pregnancy on the risk of developing JIA in the child has been demonstrated, few studies have investigated the effect of parental smoking once the disease is established. Our study did not find a statistically significant association between smoking exposure and high disease activity or poor prognosis. However, further studies including a larger number of patients are needed to assess the potential effect of parental smoking on the prognosis of JIA.