The most common chronic arthritis in children younger than 16 is now termed “Juvenile Idiopathic Arthritis” (JIA).This is an umbrella term for arthritis of unknown etiology, appeared in seven different subtypes, when other causes of arthritis are excluded.Yesterday: Chronic arthritis in children was described as Juvenile Rheumatoid Arthritis (JRA) based on terminology of Rheumatoid Arthritis (RA), since 1800s. Heterogeneity in different pictures of inflammatory arthritis in children and the differences with adult RA led to the consensus to call the disease “JIA”.Today: Different pictures and unknown etiology in the absence of pathognomonic laboratory/imaging diagnostic tools are challenging for the therapeutic decision-making which is the major goal for the patient management. The main aims of proper treatment include control of pain, restoration of range of motion and function and promotion of normal growth and development for the child to achieve a normal Quality of Life (QOL) as his/her peers.Tomorrow: To achieve this goal, we need to thoroughly examine the patient and status of the disease (Health-Related Quality of Life, HRQOL) comparing to healthy subjects of the same age and sex. Different assessment tools have been developed and validated to evaluate the HRQOL of JIA patients, including generic (CHQ, CHAQ) and disease-specific (JAFAR) tools. The most recent tool is a questionnaire developed by PRINTO (Pediatric Rheumatology International Trials Organization), named JAMAR (Juvenile Arthritis Multidimensional Assessment Report), prepared in two versions (Parent & Patient). The questionnaires comprise 110 items within 16 domains.JAMAR is being internationally validated and crossculturally adapted in 47 countries (including Iran) in an international study (EPOCA) which entitles the completion of JAMAR by JIA patients/parents and a case report form by physician for global assessment of patient’s status. We recommend the JAMAR to be implemented in the routine practice for the children with JIA.

Background Multicentric carpotarsal osteolysis (MCTO), a skeletal dysplasia presents in early childhood mimicking juvenile idiopathic arthritis (JIA). Recognition of this syndrome is essential to avoid unnecessary treatment with immunosuppressive agents because of different course and treatment. Case Report A 3-year-old boy presented with swelling and restriction of right wrist joint and left ankle joint. Possibility of Oligoarticular (or pauciarticular) JIA was considered. On evaluation his inflammatory parameters were normal. There was poor response to oral steroids and methotrexate. He was lost to follow up and presented at 9 years of age with varus deformities of hand and feet. Radiographs revealed absent carpal and tarsal bones. Based on clinical and radiological examination-MCTO was diagnosed. Oral alendronate was started and clinical improvement was noted. Conclusion Mimickers of JIA like MCTO, Farber’ s disease should be actively looked when inflammatory parameters are normal or response to therapy is not appropriate.