We describe a case of neuropathic arthropathy in the knees of a child eventually diagnosed with a hereditary sensory and autonomic neuropathy. The child was initially treated for rheumatologic disease at an outside institution. History and neurological workup revealed a neuropathy most consistent with hereditary sensory and autonomic neuropathy type II. Hereditary sensory and autonomic neuropathy should be considered in the differential diagnosis of children with joint abnormalities whose workup for an inflammatory arthropathy is negative and who exhibit diminished pain sensation on examination.