Inflammatory Arthritis

Question 1

Rheumatic disorders

Answer 1

Juvenile Idiopathic Arthritis
Dermatomyositis
Systemic lupus erythematosus

Question 2

Juvenile Idiopathic Arthritis

Answer 2

Arthritis in one or more joints for 6 weeks after excluding other causes
3 main types - classification by onset over first 6 months

Question 3

Systemic (previously Still’s disease)

Answer 3

Mainly <5years
Primarily knees, wrist, ankles and tarsals
Symmetrical
RF negative
High daily spiking fever
Salmon-pink rash
Lymphadenopathy and hepatosplenomegaly
Arthralgia, malaise and myalgia
Inflammation of pleura and serosal membranes
Often no arthritis at presentation
One-third have progressive course
Worst prognosis at younger age

Question 4

Polyarticular RF negative

Answer 4

All ages
All joints sparing MCPs
Symmetrical
Limitation of the motion of the neck and temperomandibular joints
Good prognosis but disease may be prolonged

Question 5

Polyarticular RF positive

Answer 5

Mainly females over 8 years
Small joints of hand and feet
Hip and knee affected early
Symmetrical
Rheumatoid nodules over pressure points
May be a systemic vasculitis
Funtional prognosis poor

Question 6

Oligoarticular

Answer 6

Girls - more than four joints, after 6 months - poorer prognosis)

Question 7

Investigations

Answer 7

FBC - anaemia in systemic disease
Acute-phase reactants elevated
RF - classification
ANA - classification
Xrays - soft tissue swelling early; bony erosion and loss of joint space late

Question 8

Management

Answer 8

MDT
Physio: optimize joint mobility, prevent deformity, increase muscle strength
NSAIDs - pain control and inflammation suppression
Oligo: NSAIDS and/or glucocorticoid injections, escalation to methotrexate and then a THF-alpha inhibitor
Poly: as oligo with further escalation to second TNF-alpha inhibitor
Systemic: glucocorticoids with escalation to interleukin-1 receptor agonists