7- Juvenille Rheumatoid Arthritis

Question 1

Give me some general info on Juvenile Rheumatoid Arthritis

Answer 1

Seropositive (10%)
-in the presence of rheumatoid factor the articular disease behaves similar to adult form

Seronegative chronic Arthritis (Stills disease) types:

• absence of rheumatoid factor
• onset below 16 years old
• <20% have destructive disease
• changes mainly revolve around growth disturbances, joint fusion, corticosteroid use and inactivity
• ESR elevated, anemias, leukocytosis

Question 2

what are the radiographic features of Juvenile Rheumatoid Arthritis
19
1029 txt

Answer 2

Early:

• Soft tissue swelling
• osteoporosis (loss of bone density
• periostitis (inflammation of the periosteum)

Late:

• Uniform loss of joint space
• articular erosions
• growth disturbances
• intra-articular bony ankylosis
• joint subluxation
• epiphyseal compression fractures
• growth arrest lines
• ankylosing common in hands and feet

Question 3

Juvenille RH in the spine
20 reader
1031 -txt

Answer 3

-upper segments C1-C4 demonstrate initial findings and most severe changes
0% of JRA patients will have C-spine
radiographic changes
− 30% will have instability of upper C-spine,
>5mm in kids
− C2-C4 facets may fuse, with hypoplastic
bodies, discs and spinous processes
− Spinal canal and IVF’s are unaffected
− T/L spine involvement unusual, except for
steroid induced osteopenia, T/L- spine compression deformity

Question 4

Juvenille RH in the Knee

pg 1032

Answer 4

− Epiphysis often appear very large (bulbous) − Squaring off of the patella at its inferior
pole, decreased growth of secondary center