10-18 Peds: Juvenile Idiopathic Arthritis

Question 1

Information about Juvenile Idiopathic Arthritis (JIA)

Answer 1

• Can be sudden onset or develop over time
• Sudden onset is more common
• S/S evolve over time - may require months or years to dx

Question 2

Etiology of JIA

Answer 2

• Immune system attacks own joints
• Inflammation of joints and other tissues
• Can be remitting (exacerbations and remissions); fluctuations can affect functional performance

Question 3

Signs and Symptoms of JIA

Answer 3

• Spiking Fever 1-2x/day for at least 2 weeks
• Fever + one or more of the following S/S:
• Migratory, salmon-colored rash on trunk or limbs
• Generalized lymphadenopathy
• Enlarged liver or spleen
• Serositis: inflammation of the serous tissues (lining of lungs/pleura, heart/pericardium, abdomen/peritoneum)
• Child feels ill during febrile event, but ok at other times

Question 4

JIA: Pathology

Answer 4

• Inflammation of synovial joints: Swelling, end-range stress pain, stiffness
• Appearance of enlarged joints: Bony overgrowth caused by increased blood flow to inflammed tissue; Pannus formation - causes softening and loss of cartilage
• Articular surfaces become irregular: Formation of intra-articular adhesions and osteophytes; jt congruency, alignment and stability compromised
• Pain and stiffness: Distention of jt capsule from increased synovial fluid; stretching periarticular tissue; muscle spasms
• Soft tissue changes: Muscle atrophy, muscle weakness, soft tissue shortening

Question 5

JIA: Potential Functional deficits

Answer 5

• LE Functional Deficits: Getting up from floor; walking long distances; stairs; bicycle; PE; Sports
• UE Functional Deficits: Dressing; bathing; opening jars; cutting food; handwriting
• Other motor deficits: Balance; coordination; agility; speed

Question 6

Documentation Considerations

Answer 6

• Signs of active joint inflammation
• ROM
• Muscle function
• Aerobic capacity and performance
• Growth and postural alignment
• Gait

Question 7

Intervention Goals

Answer 7

• Minimize impairments
• Maximize functional capacity and performance
• Provie education and support
• Surgery

Question 8

Pain Management

Answer 8

• Heat
• Cold
• Massage
• Splinting
• Balance between rest and exercise

Question 9

ROM and Pain

Answer 9

• Positioning during sleep
• ROM exercises
• Splinting
• Stretching
• Games to include ROM

Question 10

Muscle Performance

Answer 10

• Target muscles around joints with arthritis
• Active inflammation = maintain strength and endurance
• Concentric and eccentric of both agonist and antagonist
• Submaximal isometrics

Question 11

Aerobic Conditioning

Answer 11

• Gradually increase duration as endurance improves
• Non-impact or reduced-impact exercise when not exacerbated(swimming, walking, stationary cycling, etc.)
• Improve proprioceptive function, postural control, coordination

Question 12

Functional Activities

Answer 12

• ADLs
• Functional mobility
• Sports (mild to moderate, can participate in some sports)
• Recreational activities

Question 13

ADLs

Answer 13

• Age-appropriate ALs
• Assess child’s function using standard assessments implemented by PT (outcome measures)
• Provide education and interventions: ADLs, mobility, motor skills (Educate family on disease and process)
• Training and progress: AD, environmental modifications, adaptive equipment (Anything to make them more functional)
• Consult with school

Question 14

Functional Mobility

Answer 14

• Encourage continued WB and walking:
• Increases bone density
• Improves muscle strength
• Prevents contractures
• Shoes (lighter weight shoes)
• Orthotics (change alignment of knee joints)

Question 15

Sports and Recreational

Answer 15

• Encourage participation (music, arts, crafts, drama, computer activities, aerobic activities, PE when feasible)
• Avoid high-impact loading on inflamed on damaged joints; collision sports