Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Chronic Arthritis > Ch. 17 - Polyarticular JIA > Flashcards

Ch. 17 - Polyarticular JIA Flashcards

1
Q

How to determine RF positivity

A

Detection of RF on 2 occasions at least 3 months apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RF+ vs RF- Polyarthritis: More common

A

RF- (85%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T/F: Onset age of RF- polyarthritis reflects a biphasic trend

A

T, peaking at 1-3y then in later childhood and adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T/F: Younger onset polyarticular RF- JIA are more likely to be ANA (+)

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T/F: Younger onset polyarticular RF- JIA is correlated with a poorer outcome

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute vs insidious: Onset of RF- polyarticular JIA

A

Insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T/F: In RF- polyarthritis, joint disease predominates and extraarticular features are infrequent

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T/F: In RF- polyarticular JIA, joints are generally red and tender

A

F, warm but generally NOT red and tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MC joints affected by RF- polyartciular JIA

A

Knees, ankles, and wrists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: DIPs are commonly affected at onset in RF- poly JIA

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF- vs RF+ poly JIA: TMJ involvement

A

RF-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RF- vs RF+ poly JIA: Earlier onset

A

RF-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F: TMJ arthritis can be present without overt signs and symptoms

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: Cervical spine involvement is NOT common in early RF- poly JIA

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RF- vs RF+ poly JIA: More joints affected

A

RF+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

RF- vs RF+ poly JIA: More symmetric joint involvement

A

RF+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RF- vs RF+ poly JIA: Radiological signs of hip involvement

A

RF-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Involvement of these joints at 1st presentation has been suggested as predictor of progression to polyarthritis in those 1st presenting with oligoarthritis

A

Wrist and ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Uncommon subset of RF- poly JIA that has also been suggested to be a forme fruste of scleroderma

A

Dry synovitis (polyarthropathy with minimal or absent clinical signs of joint effusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F: Fever seldom occurs in RF- poly JIA, and if present is typically low grade

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Growth parameter measured in the assessment of growth of JIA patients

A

Height for age z score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F: Height for age of JIA patient tend to return to normal

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RF+ vs RF- poly JIA: Negative deviation in ht for age is less marked and less prolonged

A

RF-

24
Q

T/F: Growth velocity in JIA tend to correlate with disease severity and activity and with the number of involved joints

A

T

25
Q

T/F: RF- poly JIA is commonly associated with overt CV pathology

A

F

26
Q

T/F: Compared to JIA, arthritis of SLE is nonerosive

A

T

27
Q

Ddx for JIA presenting with joint contractures of the small joints of the hands BUT without associated signs of intraarticular swelling

A

Scleroderma

28
Q

Ddx for JIA that is infectious in origin and is characterized by an early migratory phase

A

N. gonorrheae arthritis

29
Q

T/F: Compared to JIA, ARF arthritis is non-erosive

A

T

30
Q

T/F: Joint involvement in malignancy tends to be polyarticular

A

F, oligoarticular

31
Q

Ddx of RF- poly JIA in children at risk for nutritional deficiencies, including those with autism and other developmental disorders

A

Scurvy

32
Q

T/F: Patients with RF- poly JIA typically have very elevated markers of inflammation

A

F, moderately elevated only

33
Q

What do RFs bind to in the immune system

A

CH2 and CH3 domains of the Fc portion of IgG

34
Q

Agglutination assays for the detection of RF typically detect what Ig subtype

A

Pentameric IgM RF

35
Q

More sensitive assay compared to agglutination assay for detection of RF

A

EIA

36
Q

Done so that hidden RFs can generate a response in agglutination assays

A

Acid elution to separate them from IgG

37
Q

Proportion of RF- poly JIA that present with (+) ANA

A

~50%

38
Q

Characteristics of JIA subgroups with (+) ANA

A

Early onset, female predominance, asymmetric arthritis, risk for uveitis

39
Q

Cells that predominate in synovial fluid of patients with RF- poly JIA

A

PMN

40
Q

Oligo vs poly JIA: Greater vascularity of the synovium on pathologic sample

A

Poly

41
Q

Mainstays of treatment in RF- poly JIA

A

Early and judicious use of pharmacotherapy
PT and OT
Promotion of healthy lifestyles
Optimal nutrition
Physical activity
Reduction of stress

42
Q

Medical management of RF- poly JIA

A

NSAIDs > MTX > Leflunomide > Anti-TNF > Anti-IL-6

43
Q

Unfavorable prognostic factors in RF- poly JIA that warrants more aggressive early treatment

A
  1. Hip and cervical spine involvement
  2. Radiographic evidence of joint space narrowing and/or bone erosions
  3. Presence of ACPA
44
Q

Indicators of moderate to severe RF- poly JIA that warrants prompt aggressive therapy

A
  1. Number of active joints
  2. Levels of inflammatory markers
  3. Poor physician and patient/parent global assessments
45
Q

RF- JIA therapy: Failure of NSAIDs to work within this time frame warrants prompt ADDITION of MTX

A

6 weeks

46
Q

RF- JIA therapy: MTX is usually given by mouth initially at a dose of

A

10-15mg/BSA/week

47
Q

RF- JIA therapy: In the absence of response to oral MTX at 10-15mg/BSA/week, dosing can be modified to

A

15-20mg/BSA/week preferably given SQ

48
Q

RF- JIA therapy: T/F Response to MTX is usually excellent

A

T

49
Q

T/F: RF status in poly JIA correlates with responsiveness to anti-TNF

A

F

50
Q

RF- JIA therapy: Patients with moderate to high disease activity who fail to respond to MTX or Leflunomide within this time frame warrants consideration of anti-TNF therapy

A

6 months

51
Q

RF- JIA therapy: Patients with low disease activity who fail to respond to MTX or Leflunomide within this time frame warrants consideration of anti-TNF therapy

A

6 months

52
Q

RF- JIA therapy: Drug that targets IL-6

A

Tocilizumab

53
Q

RF- JIA therapy: Have limited use in systemic therapy but can be a bridging agent until DMARDs become effective

A

Glucocorticoid

54
Q

RF- JIA therapy: When should focused PT be instituted

A

As soon as inflammation subsides sufficiently to facilitate the child’s cooperation

55
Q

Children with RF- poly JIA who have not remitted by this age are likely to have active arthritis into their 20s or early 30s

A

16y

56
Q

T/F: RF- poly JIA is associated with substantial morbidity in most affected children

A

T

Chronic Arthritis (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions