Idiopathic Arthritis Flashcards
Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease that affects children. It is characterised by joint inflammation, pain, and stiffness that can lead to joint damage and disability if left untreated. What is the estimated incidence of JIA?
1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000
1 - 2 cases per 100,000
More common in females
What age does Juvenile idiopathic arthritis (JIA) typically present?
1 - 0-12 months
2 - 5-10
3 - 6-15
4 - 10-25
3 - 6-15
Juvenile idiopathic arthritis (JIA) is diagnosed where there is arthritis without any other cause, lasting how long?
1 - >2 weeks in <16
2 - >6 weeks in <16
3 - >12 weeks in <16
4 - >12 months in <16
2 - >6 weeks in <16
Which of the following is NOT a key clinical feature of Juvenile idiopathic arthritis (JIA)?
1 - joint pain
2 - swelling
3 - fragility fractures
4 - stiffness
3 - fragility fractures
There are 5 main types of Juvenile idiopathic arthritis (JIA). Systemic JIA, also known as Still’s disease is a systemic illness that can occur throughout childhood in boys and girls. It is an idiopathic inflammatory condition. Which of the following are typical features of this condition?
1 - Subtle salmon-pink rash
2 - High swinging fevers
3 - Enlarged lymph nodes
4 - Weight loss
5 - Joint inflammation and pain
6 - Splenomegaly
7 - Muscle pain
8 - Pleuritis and pericarditis
9 - all of the above
9 - all of the above
In Systemic Juvenile idiopathic arthritis (JIA), are anti-nuclear antibodies and RF typically positive or negative?
- both are negative
In Systemic Juvenile idiopathic arthritis (JIA), all of the following are commonly raised, EXCEPT which one?
1 - ESR
2 - WBCs
3 - CRP
4 - platelets
5 - ferritin
2 - WBCs
In Systemic Juvenile idiopathic arthritis (JIA), a key complication is macrophage activation syndrome (MAS). This is due to a severe activation of the immune system with a massive inflammatory response. It presents with all of the following EXCEPT which feature?
1 - acutely unwell child
2 - disseminated intravascular coagulation
3 - anaemia
4 - thrombocytopenia
5 - bleeding
6 - non-blanching rash
7 - high ESR
7 - high ESR
Typically presents with a low ESR
MEDICAL EMERGENCY
If a child presents with a salmon-pink rash, fevers, joint pain and fevers for more than 5 days, which of the following non-infective differentials should be considered?
1 - Kawasaki disease
2 - Still’s disease (Systemic Juvenile idiopathic arthritis (JIA)
3 - Rheumatic fever
4 - Leukaemia
5 - all of the above
5 - all of the above
Polyarticular Juvenile idiopathic arthritis (JIA) involves inflammatory arthritis in 5 or more joints. Does this typically present symmetrical or asymmetrically?
- symmetrical
Typically both sides are affected
This is the RA in children
Polyarticular Juvenile idiopathic arthritis (JIA) involves inflammatory arthritis in 5 or more joints, commonly symmetrically. Is this confined to small or large joints?
Can affect all joints including small joints of hands and feet to hips and and knees
Polyarticular Juvenile idiopathic arthritis (JIA) involves inflammatory arthritis in 5 or more joints, commonly symmetrically. Systemic symptoms are not common, but can present with all of the following EXCEPT which one?
1 - high swinging fever
2 - anaemia
3 - reduced growth
1 - high swinging fever
Typically causes a mild fever
Systemic symptoms are typically mild
Polyarticular Juvenile idiopathic arthritis (JIA) involves inflammatory arthritis in 5 or more joints, commonly symmetrically. This is often referred to as the RA of children. Is RF always positive?
- no
Most children are negative (seronegative)
However, some children are RF positive (seropositive) and are typically older
Oligoarticular Juvenile idiopathic arthritis (JIA) is the most common form of JIA, typically affecting 4 joints or less. Does this commonly affect more or multiple joints?
- Commonly just one joint
Typically called monoarthritis and affects the knee or ankle
BUT can affect 4 or less
Oligoarticular Juvenile idiopathic arthritis (JIA) is the most common form of JIA, typically affecting 4 joints or less. Does this occur more commonly in boys or girls?
- girls
Commonly aged <6 years old
Oligoarticular Juvenile idiopathic arthritis (JIA) is the most common form of JIA, typically affecting 4 joints or less. Which is the classic associated feature of this?
1 - lung fibrosis
2 - anterior uveitis
3 - finger clubbing
4 - mouth and genital ulcers
2 - anterior uveitis
Patients should be referred to ophthalmologist for treatment
Oligoarticular Juvenile idiopathic arthritis (JIA) is the most common form of JIA, typically affecting 4 joints or less. Do patients with this condition have any systemic symptoms?
Antinuclear antibodies are often positive, however rheumatoid factor is usually negative.
- no
Inflammatory markers are mildly raised or normal
Oligoarticular Juvenile idiopathic arthritis (JIA) is the most common form of JIA, typically affecting 4 joints or less. Inflammatory markers can be mild elevated or normal. Is anti-nuclear antibodies or RF positive?
- anti-nuclear antibodies are commonly positive
- RF is typically negative
Entheses is the anatomical junction where connective tissue (e.g. ligament, tendon, joint capsule, bursa or a combination thereof) attaches to bone. Enthesitis-Related Arthritis is arthritis causing inflammation of the entheses. Is this more common in boys or girls?
- Boys aged >6 years old
Commonly referred to as the paediatric version of seronegative spondyloarthropathy group of conditions that affect adults, such as:
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
- inflammatory bowel disease-related arthritis
Entheses is the anatomical junction where connective tissue (e.g. ligament, tendon, joint capsule, bursa or a combination thereof) attaches to bone. Enthesitis-Related Arthritis is arthritis causing inflammation of the entheses. Which of the following is commonly positive in Enthesitis-Related Arthritis?
1 - HLA-B27
2 - RF
3 - HLA-DQ2
4 - HLA-DR3
1 - HLA-B27
Entheses is the anatomical junction where connective tissue (e.g. ligament, tendon, joint capsule, bursa or a combination thereof) attaches to bone. Enthesitis-Related Arthritis is arthritis causing inflammation of the entheses. When examining a patient with this, all of the following should be looked for EXCEPT which one (or at least the least likely to be present)?
1 - ankylosing spondylitis
2 - anterior uveitis
3 - osteoarthritis
4 - psoriasis
5 - IBD
3 - osteoarthritis
Entheses is the anatomical junction where connective tissue (e.g. ligament, tendon, joint capsule, bursa or a combination thereof) attaches to bone. Enthesitis-Related Arthritis is arthritis causing inflammation of the entheses. Which of the following are commonly affected?
1 - Interphalangeal joints in the hand
2 - Wrist
3 - greater trochanter of femur
4 - Quadriceps insertion at the ASIS
5 - Quadriceps and patella tendon insertion around the patella
6 - Base of achilles
7 - Metatarsal heads on the base of the foot
8 - all of the above
8 - all of the above
Juvenile Psoriatic Arthritis is another form of Juvenile idiopathic arthritis (JIA) commonly associated with psoriasis. The pattern of joint involvement varies. Does this always present with symmetrical or asymmetrical joints affected?
- Both
- symmetrical polyarthritis affecting the small joints similar to rheumatoid
OR
- asymmetrical arthritis affecting the large joints in the lower limb
Juvenile Psoriatic Arthritis is another form of Juvenile idiopathic arthritis (JIA) commonly associated with psoriasis. The pattern of joint involvement varies. Which of the following are features that should be examined if this diagnosis is suspected?
1 - Plaques of psoriasis on the skin
2 - Pitting of the nails (nail pitting)
3 - Onycholysis, separation of the nail from the nail bed
4 - Dactylitis, inflammation of the full finger
5 - Enthesitis, inflammation of the entheses
6 - all of the above
6 - all of the above
The management of all Juvenile idiopathic arthritis (JIA) should come under a rheumatologist. Which of the following is typically 1st line?
1 - NSAIDs, such as ibuprofen
2 - Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
3 - Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine and leflunomide
4 - Biologic therapy, such as the tumour necrosis factor inhibitors etanercept, infliximab and adalimumab
1 - NSAIDs, such as ibuprofen
Steroids can be effective during a flare up
DMARDs are long term medications when NSAIDs become infective or if joint damage is suspected
Biologics are used when at least 2 DMARDs have been tried
