71 Juvenile idiopathic arthritis Flashcards
What causes juvenile idiopathic arthritis?
Etiology idiopathic
If Oligoarticular - HLADR8 , HLADR5
Polyarticular - HLADR4
Enthesis associated and psoriatic - HLAB27
Possible viral and bacterial trigger
Exposure to antibiotics
Pathophysiology Of juvenile idiopathic arthritis
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
Which is the most common form of
Oligoarticular JIA
Which is arthritis involving less than 4 joints within 6 months of disease onset
What is the incidence and the seed relation of juvenileoligoarticular JIA
2-4 years old
Female
What is the pattern of joint involvement in OLIGOARTICULAR JIA
Asymmetrical
Large weight bearing joints such as knee and ankle joints
HIP JOINT NEVER!
What is the extra articular manifestations of Oligoarticular JIA
Chronic anterior uveitis
Iridocyclitis
What are the diagnosis for Oligoarticular articular JIA
High ESR
Negative RF
Positive ANA
Anemia
Leukocytosis
Treatment for Oligoarticular JIA
Nsaids
intra-articular steroid injections - triancinilone
Possible methotrexate
Good prognosis
What are the characteristic features of polyarticular JIA
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
What is the pattern for joint involvement in polyarticular JIA
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
What are the extra articular manifestation of POLYARTICULAR JIA
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
Diagnosis of polyarticular JIA
High ESR
Negative RF
Positive ANA - 40 percent
High ESR
Positive RF - Atleast two years performed three months apart
Thrombocytosis
Anemia
Leukocytosis
Treatment for polyarticular JIA
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
What is the characteristics of systemic JIA
2-4 years
Female
What is the definition of systemic JIA
STILL DISEASE
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
What is the characteristics of the joint affected in systemic JIA
Mono arthritis
Oligoarthritis
Polly arthritis
Often involving ankle knees and wrists
What are the extra articulate manifestations of systemic JIA
Transient migratory vascular salmon pink rash
Generalised lymphadenopathy
Splenomegaly or hepatomegaly
Serositis
Peritonitis
Pleuritis
Pericarditis
What are the diagnostics of of systemic JIA
High ESR High CRP and ferritin Anemia Leukocytosis Thrombocytosis RF negative
What is the treatment of systemic JIA
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
What isa prerequisite for the diagnosis of all forms of JIA
Starts before 16 and Kay’s at least 6 weeks
What are the clinical manifestations of JIA
swollen joints ( no erythema) Early morning stiffness Limited painful joint movement
Fever
Excessive crying
Lethargy
Growing pa
What are the diagnostics tests for JIA
Ultrasound of joints - synovial hypertrophy
And inarticulate fluid collection
Best to detect early bone erosion
X-ray
Synovial biopsy
Shut lamp examination
