Managing Infection Risk for Kids with Arthritis

By Linda Rath | Updated Feb. 19, 2026  

Aside from the risks of juvenile arthritis (JA) itself, one of the greatest concerns for parents of kids with JA is the risk of infection. Knowing the risk factors for infection in kids with juvenile arthritis — including infection by bacteria, viruses or fungi — can help you keep your child safe.   

What Increases Infection Risk in Kids With Juvenile Arthritis 

When JA is not well controlled, then the immune system isn’t working the way it should. Your child may also need more medication when JA is flaring that could further interfere with the body’s ability to fight off infections.  

Still, the risk is relatively low for most medications. Although there aren’t any head-to-head studies comparing infections in children and adults with autoimmune arthritis, data from large national registries show that children taking methotrexate or biologics (such as TNF inhibitors) — the most common treatments for JA — have a much lower infection risk than for adults taking the same medications, and not much higher risk than for kids with JA not taking them. 

Which Medications Raise Risk Most? 

Which juvenile arthritis medicines increase infection risk? Systemic corticosteroids, even when taken for a short period of time, can increase the risk of infection. If corticosteroids must be used, it should be at the lowest dose for the shortest time possible. (This does not apply to corticosteroids applied topically or injected directly into the joint.) 

For both adults and kids with arthritis, severe disease activity and co-existing health problems such as heart disease and obesity increase infection risk. 

Fungal Infections  

Doctors should test children for tuberculosis before starting them on a TNF-inhibitor biologic (such as adalimumab, etanercept or golimumab). Children who take these drugs also have a higher risk of fungal infections, though the risk is still low.  

Symptoms of a fungal infection in a child on a TNF inhibitor are different from those in other kids. Cough is a key symptom, so if your child is taking one of these biologic drugs and develops a bad cough that doesn’t go away, their doctor should consider fungal infection, not just other common childhood illnesses.    

When To Call the Doctor 

Cough is also one symptom of COVID, along with fever and shortness of breath, so tell your child’s doctor right away if you notice any of these symptoms. 

When children with arthritis get infections, such as chickenpox or the flu, the illness may be more serious than in kids without arthritis.  

But recent research suggests that children with JA have a relatively low risk of severe coronavirus infection. Data from three international rheumatology databases found that only 10% of children with juvenile idiopathic arthritis (JIA) were hospitalized with COVID-19 and most weren’t seriously ill. Treatment with biologics, including TNF inhibitors, didn’t appear to put kids at higher risk of severe COVID-19, either. Researchers who studied the data say parents should be reassured by these findings. 

One cause for concern: Children who don’t have an autoimmune disease can develop one after a COVID-19 infection. 

COVID and MIS-C 

Although most kids with arthritis don’t seem at special risk of COVID-19, any child — even those with mild cases — can develop a rare, very serious complication called multisystem inflammatory syndrome in children (MIS-C). It can cause severe inflammation in organs and tissues throughout the body, including the heart, kidneys, blood vessels, digestive system, skin and eyes. The most common symptoms seem to involve the digestive tract and heart, but may also include: 

• A fever that lasts 24 hours or longer 
• Vomiting 
• Skin rash 
• Fatigue 
• Fast breathing or heartbeat 
• Red eyes 
• Headache, dizziness, or lightheadedness 

If your child develops severe stomach pain, trouble breathing or, depending on skin tone, pale or bluish skin, lips or nails, get emergency care right away. 

No one is sure what causes MIS-C or why some kids get it and others don’t, but it seems to be an extreme immune response to COVID-19. Some of the first cases were diagnosed as Kawasaki disease, a rare type of vasculitis with many symptoms similar to MIS-C. Subsequent research has shown that while the two have some features in common, they’re separate conditions. 

Most kids recover from MIS-C with treatment — usually a combination of corticosteroids and intravenous (IV) immunoglobulin— but some who have gotten sick very rapidly haven’t survived. 

How to Lower Infection Risk at Home and School 

Parents can help protect their children by making sure they receive age-appropriate immunizations, including an annual flu shot.  

Are vaccines safe for kids with juvenile arthritis? Yes, with some important exceptions: Most children taking arthritis medication should avoid live vaccines (including the chickenpox vaccine, MMR vaccines or the nasal flu vaccine) because the vaccines themselves increase the risk of serious illness.  

Other immunizations, such as hepatitis A, hepatitis B, meningitis and the human papillomavirus vaccinations, are all safe. All members of the household should be immunized to reduce the exposure risk to children with arthritis.  

Regularly disinfecting frequently touched household surfaces such doorknobs and faucets might also help. Requesting that other shared surfaces — the barre in your daughter’s ballet class, the wrestling mats in the school gym, for example — be cleaned, as well, can also help reduce the risk of infection.   

Never stop arthritis medications without first consulting your child’s doctor, especially when a child gets sick. Doing so could reactivate the disease and have longer-lasting consequences than most infections. 

Talking to Your Child  

Practicing good hygiene and frequent hand washing are the most important things kids can do to prevent infection. And warn your child about the risks of sharing drinks, food and lip balm. Most kids with arthritis can live like other kids as long as they are aware of risks and parents are watchful.