The differential diagnosis includes JRA (especially systemic-onset JRA and, less so, polyarticular JRA), Lyme disease, reactive arthritis, arthropathy of sickle cell disease, leukemia or other malignancy, SLE, embolic bacterial endocarditis, serum sickness, Kawasaki disease, drug reactions, and gonococcal arthritis. These are frequently distinguished by history or specific laboratory tests. The absence of an antecedent GAS infection, the diurnal variation of the fever, evanescent skin rash, and prolonged symptomatic joint inflammation usually distinguish systemic-onset JRA from ARF.