JIA Flashcards

1
Q

how common is JIA

A
  • most common rheumatologic disease in children
  • 2-23/100 000
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2
Q

causes of JIA

A
  • not completely understood
  • some genetic susceptibility
  • immune response
  • pro-inflammatory markers - TNF, IL-1, 2
  • antibodies
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3
Q

features of JIA

A
  • 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
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4
Q

DDx for JIA

A
  • septic arthritis
  • osteomyelitis
  • transient synovitis
  • malignancies e.g. lymphoma, neuroblastoma, bone tumours
  • recurrent haemoarthrosis
  • vascular abnormalities
  • trauma
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5
Q

signs of JIA

A
  • 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
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6
Q

classifications of JIA

A
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7
Q

exclusions for each category in order to avoid cross over

A
  • 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
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8
Q

JIA pattern of onset

A

4 or fewer joints/large joints no symmetry

→ oligoarthritic or pauciarticular (40-60%)

→ early

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9
Q

polyarticular JIA patterns of onset

A
  • 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
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10
Q

enthesitis related JIA features

A

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
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11
Q

enthesitis exam

A
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12
Q

psoriatic JIA features

A

chronic arthritis and definite psoriasis is evident

HLA B27+ve

plus 2 out of:

  • dactylitis: finger/toe inflamamtion
  • onycholysis: nail pitting
  • FHx psoriasis
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13
Q

how common is systemic JIA

A

5-15% of JIA

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14
Q

features of systemic JIA

A
  • unwell
  • arthritis
  • intermittent fever >2wks
  • salmon pink erythematous rash
  • generalised lymphadenopathy
  • serositis
  • hepatomegaly/splenomegaly
  • high inflammatory markers
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15
Q

pGALS MSK screen questions

A
  • 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
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16
Q

investigations for JIA

A

labs

x-ray

US

MRI w/ contrast

17
Q

label the diagram

A
18
Q

normal joint vs OA and RA

A
19
Q

goals of treatment

A
  • 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
20
Q

intra-articular steroids - effectiveness

A
  • highly effective
  • remission >6mth 84%
  • greater success in oligoarticular JIA
  • safe and effective
  • no long term SEs
21
Q

DMARDs - effectiveness

A
  • 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
22
Q

biologics - when are they used and effectiveness

A
  • failure to respond to DMARD
  • anti-TNF agents commonly used
  • good safety profile
  • newer biologics available
23
Q

uveitis in JIA

A
  • 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
24
Q

features of uveitis in JIA

A
  • <5yrs
  • rarely symptomatic
  • red eyes, headache, reduced vision
  • long term effects: cataracts, glaucoma, blindness
25
Q

treatment of uveitis

A
  • 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
26
Q

complications of JIA

A

poor growth

localised growth disturbances

micrognathia

contractures

ocular complications