JIA

Question 1

Firstly how would you expect the affected joint to appear in JIA?

Answer 1

Swollen
Painful
Morning Stiffness
Limited ROM (by both fluid & pain)
Held in most comfortable position

Question 2

What kind of systemic symptoms could you get with JIA?

Answer 2

Rash
Fever
Fatigue
Poor Appetite
Wt loss
Lymphadenopathy
Uveitis

Question 3

In General how is JIA treated?

Answer 3

Step wise:
1) IA steroids
2) DMARDs e.g. MTX (needs blood monitoring)
3) Biologics e.g. Anti-TNF

Regular ophthalmology screening for Uveitis

Question 4

If a JIA child has Uveitis how do we treat to prevent cataracts, glaucoma and blindness?

Answer 4

Topical Steroid
Systemic Steroid
DMARDs
Biologics

Question 5

What tests can you do if you suspect JIA?

Answer 5

ANA
RF
FBC
Inflammatory Markers (TNF, IL-1 & 2)

Sometimes X-ray, US or MRI with contrast

Question 6

There are 3 main types of JIA:

Answer 6

Pauciarticular (<5 joints) — Most common
Polyarticular (5+ joints)
Systemic Onset (Still’s Disease)

Also can get Enthesitis related JIA & Psoriatic JIA

Question 7

How would you expect Pauciarticular JIA to present?

Answer 7

4- joints
Large joints

Early (<5yrs) = ANA +ve, high rate of uveitis & in knees/ankles/hands/wrists/feet

Late (>8yrs) = ANA -ve, no extra-articular stuff & hip involvement

Question 8

How would you expect to see polyarticular JIA?

Answer 8

5+ joints
Again few systemic signs
Mostly Large joints
Ass with TMJ injury –> limited bite & micrognathia

Early (<5) are mostly RF -ve
Late >8 are mostly RF +Ve

Question 9

What characterises Still’s Disease?

Answer 9

Systemically Unwell
Fever (spikes daily & starts well before joint symptoms)
Salmon Erythematous Rash
Generalised Lymphadenopathy
Serositis (Pleurisy, pericarditis etc)
Hepatosplenomegaly

Arthritis!