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function in school and social domains, as well as physical function. Moreover, optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as standard pharmacologic interventions. The course of juvenile polyarticular arthritis is often unpredictable but most frequently is fluctuating, with periods of flare and quiescence. Periods of flare are characterized by increased disease activity and worsening symptoms, such as pain, fatigue, morning stiffness, and increased functional difficulties. Although not well characterized in the pediatric literature, pain is generally considered to be a clinically significant symptom of juvenile polyarticular arthritis, by the children themselves as well as by their parents and siblings (1, 2). Previous cross-sectional studies have shown that pain and discomfort are prevalent in juvenile polyarticular arthritis (1, 3, 4). Children usually report pain intensity in the mild to moderate range (1, 4-8). However, our research has shown considerable variability in the pain ratings of children with juvenile polyarticular arthritis, with as many as 25% of children reporting pain intensity in the higher ranges on pain measurement scales (5). Pain and discomfort in children with arthritis can impair function by limiting leisure and physical activities, disrupting school attendance and sports participation, and impeding independent daily hygiene and self-care activities. Indeed, research suggests that children with arthritis are at increased risk for the development of psychosocial problems including depression, decreased self-esteem, decreased scholastic and social competence, and difficulty with peer relationships (9-11). Moreover, children with more severe arthritis or increased functional disability may be at increased risk for adjustment difficulties (9, 12, 13). Several recent studies used daily diaries to examine pain and associated symptoms in children with chronic conditions such as sickle cell disease, headache, and functional abdominal pain (14-17). These studies revealed a number of advantages of daily diaries over periodic assessments. Diaries allow children to track pain and related symptoms on a day-to-day basis, thereby improving recall of minor pain episodes and reducing recall bias (18, 19). As previously demonstrated in other groups of children with chronic illness, diaries also provide information about the temporal sequencing of events, making it possible to analyze the relationship of pain to behavioral responses such as activity reduction that may place children at increased risk for adjustment difficulties (17, 20). In our previous 7-day diary study of children with juvenile rheumatic disease, we reported the successful use of a diary in children older than age 6 years, and documented daily fluctuations in disease symptoms (21). The purpose of the present study was to analyze patterns of pain, stiffness, and fatigue related to juvenile polyarticular arthritis, using daily diaries over a 2-month period of time. In addition, we assessed the relationships of demographic variables such as age and sex, measures of disease severity, and psychological adjustment to daily disease symptoms. Finally, we examined daily disease symptoms as predictors of reduced participation in school and social activities. PATIENTS AND METHODS Participants. From December 1998 through October 2001, children between the ages of 8 and 18 years with a previous diagnosis of polyarticular arthritis were sequentially recruited from the Duke University Medical Center pediatric rheumatology clinic to participate in a daily diary study of arthritis pain and symptoms in juveniles.