21 - Juvenile idiopathic arthritis

Question 1

define JIA?

Answer 1

Group of systemic inflammatory disorders affecting children below age of 16 years

Question 2

what can JIA lead to?

Answer 2

disability and blindness

Question 3

what type of disease is JIA?

Answer 3

auto-immune

Question 4

which 3 factors affect the pathogenesis of JIA?

Answer 4

genetic, environmental and immunological

Question 5

age of onset (diagnosis)?

Answer 5

<16 years

Question 6

duration of disease (diagnosis)?

Answer 6

> 6 weeks

Question 7

describe the presence of arthritis to make a diagnosis?

Answer 7

joint swelling or 2 of the following -

1 - painful/ limited joint motion, 2 - tenderness, 3 - warmth

Question 8

M:F type 1 JIA?

Answer 8

F>M (8:1)

Question 9

describe type 1 JIA?

Answer 9

peak age - 1-3 years, irregular iris due to posterior synechiae

Question 10

describe type 2 JIA?

Answer 10

after age 8-9, M:F = 7:1

Question 11

describe type 3 JIA?

Answer 11

any age during childhood, M:F = F>M (4:1)

Question 12

what is the most common type of JIA?

Answer 12

pauciarticular JIA (4 joints or less)

Question 13

what is the 2nd most common type of JIA?

Answer 13

polyarticular JIA (5+ joints)

Question 14

describe RF -ve polyarticular JIA?

Answer 14

any age, often early, F:M = 9:1

Question 15

describe RF +ve polyarticular JIA?

Answer 15

late childhood (teens, 12-16 years), F:M = 7:1

Question 16

what is the least common type of JIA?

Answer 16

systemic onset JIA

Question 17

how is systemic onset JIA AKA?

Answer 17

Still’s disease

Question 18

what defines still’s disease?

Answer 18

extra-articular features - start early and disappear after 2-5 years

Question 19

age affected by Still’s disease?

Answer 19

throughout childhood (4-6 years)

Question 20

M:F Still’s Disease?

Answer 20

F>M = 1.5:1

Question 21

how does fever present in Still’s disease?

Answer 21

rises to 39.5 degrees C daily for at least 2 weeks - late in afternoon/ evening and returns to normal in morning

Question 22

how does a rash present in Still’s disease?

Answer 22

over 90% patients, evanescent salmon red eruption on trunk and thighs

Question 23

what phenomenon can be seen with the rash in Still’s disease?

Answer 23

+ve Koebner’s phenomenon - rash brought on by scratching

Question 24

what is 1st line therapy for JIA?

Answer 24

simple pain killers - NSAIDs

Question 25

what should 2nd line treatment be for JIA?

Answer 25

joint (steroid) injections

Question 26

what is the role of topical steroids in JIA?

Answer 26

rehabilitation - physiotherapy and occupational therapy

Question 27

surgical treatment in JIA?

Answer 27

1 - synovectomy, 2 - reconstructive/ joint replacement surgery