There are a wide variety of conditions that need to be excluded before a diagnosis of juvenile chronic arthritis can be made. Amongst these rheumatic fever and hematological problems are amongst the foremost.

• Rheumatic fever: often occurs between the ages of 5-15yrs. Although it occurs after a streptococcal sore throat, the throat infection may be so mild that it is often missed. The joint involvement is flitting and fleeting in nature, often lasting in one joint for a few days before involving another joint. It tends to affect the large joints and characteristically does not lead to the damage of the joint. Heart affliction is common and needs to be evaluated in each and every patient. Treatment includes anti-inflammatory agents, prednisolone when severe and prophylaxis to prevent recurrent attacks. Often the prophylaxis to prevent recurrent attacks is continued for many years.
  
  
• Hematological malignancies: In young children who present with severe systemic features like fever, weight loss, bone pains, the differential diagnosis of acute leukemias should be entertained. This may need amongst other investigations a bone marrow examination. Giant strides have been made in the last decade in the management of leukemias and, the morbidity and mortality has improved considerably.