Arthritis in children Flashcards
Juvenile Oligoarthritis
Most common form of JIA (50-60%) – 4 or less joints (knees, ankles, wrists) often asymmetrically
Mainly affects girls with peak onset at 3yrs
Most will eventually remit but Uveitis (with positive ANA) is a possible complication which can blind if untreated
Juvenile idiopathic arthritis (JIA)
The most common cause of Arthritis in people under 16
Mostly RF negative so changed to idiopathic from rheumatoid
Systemic onset JIA (Still’s disease)
10% of JIA – gender equal up to 5yrs and after affects girls more
Presents with >39C fever and evanescent maculopapular rash with arthralgia, arthritis, myalgia and general lymphadenopathy (+hepatosplenomegaly, pericarditis & pleurisy) –> Macrophage activation syndrome is a potentially fatal complication
Investigations of Still’s disease (5)
High ESR and CRP
Neutrophilia and thrombocytosis
Autoantibodies are negative
Extended Oligoarthritis
In 25% of pts with oligoarthritis it extends to affect more joints after 6months –> this can be very destructive
RF positive Polyarticular JIA
Occurs in older girls (>8yrs) - also anti-CCP positive often
Starts with smaller joints and progresses to larger ones
A potentially very destructive disease which requires aggressive treatment
RF negative Polyarticular JIA
Commoner form which affect mostly girls under 12yrs
Similar pattern to RF positive form but asymmetrical
Can also affect cervical spine, TMJ and elbows
Pts may be ANA positive and at risk of chronic Uveitis
Enthesitis related arthritis (juvenile spondyloarthropathy)
Teenage and young boys with an asymmetric lower limb arthritis and enthesitis - associated with HLA-B27 & risk of iritis – child version of AS but spinal involvement is rare in children –> 1/3 will develop spinal disease in adulthood
Juvenile psoriatic arthritis
Similar pattern to adult psoriatic arthritis and can be very destructive – Psoriasis may develop years later but there is often a family history
Treatment of JIA
Should always be referred to specialist centres to design a treatment plan to prevent long term disability
NSAIDs treat pain/stiffness but DMARDs are needed to control the progression
Medication for JIA (4)
Pulsed IV methylpred followed by methotrexate(10-15mg/m2) weekly is used to control disease –> If this fails use anti-TNF agents – this is highly effective except for systemic onset disease
Treatment of Enthesitis related arthritis
Sulfasalazine in addition to NSAIDs and steroids
Aspirin for pain relief
Aspirin can cause pethes disease and should not be used in children under the age of 12yrs
Prognosis of JIA
Before biologics 50% suffered long term disability ad 25% had active arthritis into adulthood –> much improved now but long term data is not avaliable yet
Transient synovitis (irritable hip)
Typically in 2-10yr olds. Commonest cause of hip pain in children. acute hip pain associated with viral infection.
