Arthritis Flashcards
What is juvenile idiopathic arthritis?
oimmune inflammation in joints, lasting more than 6 weeks in a patient under 16
Features of inflammatory arthritis
Joint pain
Swelling
Stiffness
What are the five key subtypes of juvenile inflammatory arthritis?
Systemic JIA
polyarticular JIA
Oligoarticular JIA
Enthesis related arthritis
Juvenile psoriatuc arthritis
What is Stills disease?
Systemic illness can occur throughout childhood in boys and girls, idiopathic inflammatory condition
Typical features of systemic JIA
Subtle salmon-pink rash
High swinging fevers
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritis and pericarditis
Are antinuclear antibodies and rheumatoid factors positive or negative in Systemic JIA?
Negative
What blood tests are positive in systemic JIA?
Raised inflammatory markers
Raised CRP, ESR, platelets, serum ferritin
Why raised ferritin
What is a key complication of systemic JIA?
MAS - macrophage activation syndrome
What is a MAS?
Severe activation of the immune system with a massive inflammatory response.
What complication of Stills disease does low ESR suggest?
Macrophage activation syndrome
How does MAS present?
Acutely unweel child with DIC, anaemia, thrombocytopenia, bleeding and non blanching rash - life threatening
How does MAS present?
Acutely unweel child with DIC, anaemia, thrombocytopenia, bleeding and non blanching rash - life threatening
What is Polyarticular JIA?
5 often symmetrical joints + of idiopathic inflammatory arthritis
Can affect small joints hands or feet or large joints eg hips and knees
Equivalent of rheumatoid in children
Systemic symptoms of polyarticular JIA
Minimal
Mild fever, anaemia, reduced growth
What test is done for polyarticular arthritis?
Rheumatoid factor - seronegative or positive
Which patients with polyarticular arthritis tend to be seropositive?
Older children and adolescenets, disease pattern more similar to rheumatoid arthritis in adults
Oligoarticular JIA what is it?
<4 joints, often monoarthritis (1), of larger joints eg knee or ankle
What group of people is more likely to get oligoarthrtiis?
Girsl under 6 uears
What condition is classically ass with oligoarticular JIA and enthesitis related arthritis?
Anterior uveitis
Investgiations outcomes for oligoarticular arthritis
Tend not to ahve systemic symptoms and normally or slightly elevated inflammatory markers
Antinuclear antibodies often positive
Rf normally negative
What is enthesitis related arthritis?
Paeds version of seronegative spondyloarthropathy
What conditions come under seronegative spondyloarthropathy?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
IBD arthritis
What is the enthesis?
Point at which the tendon of a muscle inserts into a bone
What causes enthesitis?
Traumatic stress
Repetitive strain during sporting activities
autoimmunitiy
What gene is ass with enthesis-related arthritis?
HLA-B27
What to conditions to cover in history that are ass with enthesitis?
HLA-B27 related
eg Psoriasis - psoriatic plaques and nail pitting
IBD - intermittent diarrhoea and rectal bleeding
Uveitis
Where to palpate for enthesitis?
Interphalangeal joints in hand
Wrist
Over greater trochanter on lateral aspect of hip
Quadriceps insertion at anterior superior iliac spine
Quadriceps and patella tendon insertion around patella
Base of achilles at calcaneus
Metatarsal heads on base of foot
What is Juvenile psoriatic arthritis?
seronegative inflammatory arthritis ass with psoriasis
Joint involvement in juvenile psoriatic arthritis?
Small joints symmetrical - similar to rheumatoid
Asymmetrical - large joints in lower limb
Medical treatment for JIA
NSAIDs
Steroids - oral, IIM, intra-articular in oligoarthritis
Disease modifying anti-rheumatic drugs - methotrexate, sulfasalazine + leflunomide
Biologic therapy - tumour necrossi factor inhibitors - etanercept, infliximab, adalimumab
How to manage arthritis non pharmcological
Education and support
Mental health check ins and support for LTCs
