Juvenile idiopathic arthritis with no complaints of joint pain in early childhood

We describe three children with polyarticular juvenile idiopathic arthritis (JIA) with no complaint of joint pain. Disease onset occurred in infancy. They experienced delays in diagnosis of JIA due to lack of pain, despite clinical and ultrasound findings consistent with active synovitis. Rheumatoid factor and anti-CCP antibody were not detected in any case. All three children were refractory to methotrexate, so were given adalimumab, a fully humanized antibody against soluble TNF-α. Diagnosis of JIA should not be excluded due to lack of joint pain.