JIA Flashcards
how common is JIA
- most common rheumatologic disease in children
- 2-23/100 000
causes of JIA
- not completely understood
- some genetic susceptibility
- immune response
- pro-inflammatory markers - TNF, IL-1, 2
- antibodies
features of JIA
- arthritis for ≥6wks
- morning stiffness or gelling
- irritability/refusal to walk in toddlers
- school absence or limited ability to participate in physical activity
- rash/fever
- fatigue
- poor appetite/weight loss
- delayed puberty
DDx for JIA
- septic arthritis
- osteomyelitis
- transient synovitis
- malignancies e.g. lymphoma, neuroblastoma, bone tumours
- recurrent haemoarthrosis
- vascular abnormalities
- trauma
signs of JIA
- swelling: periarticular soft tissue oedema, intraarticular effusion, hypertrophy of synovial membrane
- tenosynovitis (swollen tendons)
- pain
- joint held in position of max comfort
- ROM limited at extremes
classifications of JIA
exclusions for each category in order to avoid cross over
- psoriasis or hx of in the pt or 1st degree relative
- arthritis in HLA-B27+ve male beginning >6y/o
- ankylosing spondylitis, enthesitis related arthritis, sacroiliitis w/ IBD or acute anterior uveitis or a hx of one of these in 1st degree relative
- presence of IgM rheumatoid factor and at least 2 occasions at least 3mths apart
- presence of systemic JIA
- RF
JIA pattern of onset
4 or fewer joints/large joints no symmetry
→ oligoarthritic or pauciarticular (40-60%)
→ early
polyarticular JIA patterns of onset
- can be acute but is mostly insidious
- large fast growing joints are mostly affected
- TMJ joint injury is common leading to limited bite and micrognathia
- systemic manifestations rare: fever, slight hepatosplenomegaly, lymphadenopathy, pericarditis, chronic uveitis
enthesitis related JIA features
inflammation of enthesis along with arthritis
plus 2 out of:
- inflammatory spinal pain
- sacroiliac joint tenderness
- FHx of enthesitis related JIA
- onset of poly/oligoarthritis in a boy >8y/o
- HLA B27+ve
- acute anterior uveitis
enthesitis exam
psoriatic JIA features
chronic arthritis and definite psoriasis is evident
HLA B27+ve
plus 2 out of:
- dactylitis: finger/toe inflamamtion
- onycholysis: nail pitting
- FHx psoriasis
how common is systemic JIA
5-15% of JIA
features of systemic JIA
- unwell
- arthritis
- intermittent fever >2wks
- salmon pink erythematous rash
- generalised lymphadenopathy
- serositis
- hepatomegaly/splenomegaly
- high inflammatory markers
pGALS MSK screen questions
- do you/your child have any pain or stiffness in the joints, muscles or back
- do you/your child have any difficulty getting dressed w/o help
- do you/your child have any problem going up and down stairs
investigations for JIA
labs
x-ray
US
MRI w/ contrast
label the diagram
normal joint vs OA and RA
goals of treatment
- pharmacologic management: NSAIDs, DMARDs, biologic agents, intra-articular/oral steroids
- psychosocial factors: incl counselling for pts and family
- school performance: school life adjustments, physical education adjustments
- nutrition: anaemia, generalised osteoporosis
- PT: relieve pain, address ROM, muscle strength, ADLs, conditioning exercises
- OT: joint protection, programme to relieve pain, ROM, ADLs
intra-articular steroids - effectiveness
- highly effective
- remission >6mth 84%
- greater success in oligoarticular JIA
- safe and effective
- no long term SEs
DMARDs - effectiveness
- methotrexate
- poor response to IAS in oligo JIA
- commonly used
- should be used early for good outcome
- most given injectable (SC) form
- not many SEs
- blood monitoring
biologics - when are they used and effectiveness
- failure to respond to DMARD
- anti-TNF agents commonly used
- good safety profile
- newer biologics available
uveitis in JIA
- untreated can progress to chronic uveitis
- all children diagnosed w/ JIA undergo screening → early detection prevents complications
- uveitis more common in ANA+ve oligo JIA
features of uveitis in JIA
- <5yrs
- rarely symptomatic
- red eyes, headache, reduced vision
- long term effects: cataracts, glaucoma, blindness
treatment of uveitis
- slit lamp examination
- all JIA pts seen within 6wks of diagnosis
- high risk children
- initially topical steroids to reduce inflammation, more severe need systemic
- poor response to steroids → DMARD and biologics
- early detection and treatment → good prognosis
complications of JIA
poor growth
localised growth disturbances
micrognathia
contractures
ocular complications
