71 Juvenile idiopathic arthritis

Question 1

What causes juvenile idiopathic arthritis?

Answer 1

Etiology idiopathic

If Oligoarticular - HLADR8 , HLADR5

Polyarticular - HLADR4

Enthesis associated and psoriatic - HLAB27

Possible viral and bacterial trigger

Exposure to antibiotics

Question 2

Pathophysiology Of juvenile idiopathic arthritis

Answer 2

Chronic synovial inflammation with infiltration of plasma cells
B lymphocytes
T lymphocytes

Joint capsule hyperplasia

Growth of fibrovascular connective tissue or pannus

Invasion of articular surface

Question 3

Which is the most common form of

Answer 3

Oligoarticular JIA

Which is arthritis involving less than 4 joints within 6 months of disease onset

Question 4

What is the incidence and the seed relation of juvenileoligoarticular JIA

Answer 4

2-4 years old

Female

Question 5

What is the pattern of joint involvement in OLIGOARTICULAR JIA

Answer 5

Asymmetrical
Large weight bearing joints such as knee and ankle joints

HIP JOINT NEVER!

Question 6

What is the extra articular manifestations of Oligoarticular JIA

Answer 6

Chronic anterior uveitis

Iridocyclitis

Question 7

What are the diagnosis for Oligoarticular articular JIA

Answer 7

High ESR
Negative RF
Positive ANA

Anemia
Leukocytosis

Question 8

Treatment for Oligoarticular JIA

Answer 8

Nsaids

intra-articular steroid injections - triancinilone

Possible methotrexate

Good prognosis

Question 9

What are the characteristic features of polyarticular JIA

Answer 9

Seronegative - second most common
Occurs in 1-4
6-12
More females

Seropositive
9-12 years
More common in female

Arthritis involving more than 5 joints within 6 months of disease onset

Question 10

What is the pattern for joint involvement in polyarticular JIA

Answer 10

Seronegative
Symmetrical or asymmetrical of both large and small joints
Cervical spine
Tempromandibular joints also affected

Seropositive
Symmetrical joint involvement of the smaller joints such as the inter pharyngeal joints

Question 11

What are the extra articular manifestation of POLYARTICULAR JIA

Answer 11

Seronegative -
all anterior uveitis - asymptomatic ( but if untreated glaucoma cataracts optic nerve damage)
Iridocyclitis

Seropositive- rheumatoid noodles on the extensor surface of the elbows and Achilles‘ tendon

Question 12

Diagnosis of polyarticular JIA

Answer 12

High ESR
Negative RF
Positive ANA - 40 percent

High ESR
Positive RF - Atleast two years performed three months apart

Thrombocytosis
Anemia
Leukocytosis

Question 13

Treatment for polyarticular JIA

Answer 13

Methotrexate
NSAIDS

Biologic agents
Indicated if the response to DMARDs is poor.
Examples: etanercept, adalimumab,

Seronegative
High risk of functional limitation

Seropositive
Persistent disease with periodic exacerbation and high risk of joint detection

Question 14

What is the characteristics of systemic JIA

Answer 14

2-4 years

Female

Question 15

What is the definition of systemic JIA

STILL DISEASE

Answer 15

Arthritis involving 1 or more joints
With intermittent fever that lasts Atleast two weeks with fever spikes occurring in 3 consecutive days
And Atleast one extra articular manifestations

Question 16

What is the characteristics of the joint affected in systemic JIA

Answer 16

Mono arthritis
Oligoarthritis
Polly arthritis

Often involving ankle knees and wrists

Question 17

What are the extra articulate manifestations of systemic JIA

Answer 17

Transient migratory vascular salmon pink rash

Generalised lymphadenopathy

Splenomegaly or hepatomegaly

Serositis
Peritonitis
Pleuritis
Pericarditis

Question 18

What are the diagnostics of of systemic JIA

Answer 18

High ESR
High CRP and ferritin
Anemia
Leukocytosis
Thrombocytosis
RF negative

Question 19

What is the treatment of systemic JIA

Answer 19

NSAIDs
- indomethacin ( highly effective in JIA)
Naproxen, ibuprofen

Poor response to methotrexate
And TNF inhibitors - etanercept adalimumab

A short course of systemic glucocorticoid therapy if
Severe systemic involvement (e.g., severe acute anterior uveitis)

Supportive therapy - physiotherapist
Surgery

Complete remission occurs in 40 percent but the disease is very variable

Question 20

What isa prerequisite for the diagnosis of all forms of JIA

Answer 20

Starts before 16 and Kay’s at least 6 weeks

Question 21

What are the clinical manifestations of JIA

Answer 21

swollen joints ( no erythema) 
Early morning stiffness
Limited painful joint movement

Fever

Excessive crying
Lethargy
Growing pa

Question 22

What are the diagnostics tests for JIA

Answer 22

Ultrasound of joints - synovial hypertrophy
And inarticulate fluid collection
Best to detect early bone erosion

X-ray

Synovial biopsy

Shut lamp examination