JIA

Question 1

What is JIA

Answer 1

diverse group of arthritis conditions with unkown cause that begins BEFORE 16 and lasts atleast 6 weeks

Question 2

How many weeks must JIA last?

Answer 2

at least 6 weeks

Question 3

How is JIA charcaterized

Answer 3

joint inflammation, pain, stiffness, and swelling in one or more joitns

Question 4

Is it symmetrical or not?

Answer 4

Compared to adult RA it is less symmetrical (known as juveinile rheumatoid arthritis) (JRA)

Question 5

What may predispose you to JIA

Answer 5

Genetics, environmental afctors, and infections
F>M

Question 6

What is oligoarticular JA

Answer 6

invovled 4 or less joints in the first 6 months
* Most common subtype
* most prevelant in large joitns (knee), ankles, and elbows
*AKA Pauciarticular JIA

Question 7

Polyarticular

Answer 7

Involves 5 or MORE joints in the first 6 months

Question 8

Systemic JIA

Answer 8

Invovles joitn inflammation along with a fever and other symptoms during the first 6 months

Question 9

What is enthesitis JIA

Answer 9

Associated with inflammation of the entheses, where tendons or ligaments attach to bone within the first 6 months

Question 10

What is Psoriatic JIA

Answer 10

linked to Psoriasis, a skin condition, within the first 6 months

Question 11

What are the 4 main clinical features of JIA

Answer 11

Joint: Swelling, END-RAND STRESS PAIN,s tiffness, especially in the morning or after inactivity

Systemic (subtype): fever, fatigue, and rash

Growth abnormalities; Chronic inflammation can lead to growth disturbances and limb length discrepancies

Other symtpoms: Muscle weakness and atrophy, eye disease (uveitis), and fatigue*

Question 12

What happens in the C-Spx

Answer 12

Loss of lordosis

Question 13

TMJ

Answer 13

Micrognathia (small jaw) and altered teeth occlusion

Question 14

TSpx

Answer 14

Scoliosis secondary to LONG STANDING LLD

Question 15

Lumbar Spx

Answer 15

Excessive Lordosis SECONDARY TO HIP FLEXION CONTRACTURE

Question 16

Shoulders

Answer 16

Over growth of humeral head and irregular shape

Shallow glenoid fossa with increased risk of subluxation

Question 17

Elbows

Answer 17

overgrowth of the radial head restricts ROM (ESPECIALLY EXT)
- ulnar N entrapment

Question 18

Wrist

Answer 18

rapid loss of EXT: shortening of flexors, volar subluxation
Wrists rest in flexion and ulnar deviation

Question 19

Hand

Answer 19

PIP contractures more common THAN DIP
Marked decrease in grip strength

Question 20

Hip

Answer 20

Femoral head overgrowth
Limited weightbearing in young children - lead to shallow acetabulum and trochanteric growth abnormalities

Flexion contracture the most common(may be masked by lumbar lordosis)

Question 21

Knee

Answer 21

MOST COMMON
- Rapid weakness and atrophy of quadriceps
Knee flexion contracture due to shortening of hamstrings, TFL and ITB

• Overgrowth of distal femur contributes to LLD in unilateral diseases

Chronic synovitis causes overgrowth of the femoral condyle, RESULTING IN VALGUS DEFORMITY

Question 22

Ankle and foot

Answer 22

Altered growth causes bony changes in the tarsals, with potential for fusion

Question 23

How do we diagnose?

Answer 23

Diagnosis of exclusion, based on history, physical examination, lab tests and imaging

Question 24

Thermal Therapy (Symptom management)

Answer 24

• exercising in a warm pool relieves pain and imporves mobility
• Superficial or deep heat applied over the inflamed joints is CONTRAINDICATED
• locally applied cold decreases intraarticular temperatures and can reduce joint pain

Question 25

Balance rest and exercise (Symptom management)

Answer 25

- SLeep hygiene (poor sleep exacerbates pain) - Shor rests throughout the day

Question 26

Joint protection (Symptom management)

Answer 26

orthotics, splints and braces

Question 27

Cognitive behavioral techniques (Symptom management)

Answer 27

- progressive muscle relaxation - Meditative breathing - Guided immagery - EMG biofeedback

Question 28

Thermal Therapy (Therapeutic exercises)

Answer 28

- ROM and flexibility exercises - Education on proper resting positions to limit contractures - Daily active or AAROM as tolerated for all active and adjacent joitns NO Stretching if acute

Question 29

Aerobic activity (Therapeutic Exercises)

Answer 29

ACUTE: low intesity, low-impact activities such as walking or low imapct dancing are recomended Chronic: accumalate 60 mins of moderate-vigorous PA per day. Biking, aerobic dance, swimming

Question 30

Strength Training (Therapeutic Exercises)

Answer 30

ACUTE: Submax Isometric strengthening contraactions performed AT MULTIPLE POINTS within available PAIN FREE ROM (minimize atrophy and strength loss) Under medical control: dynamic resistance exercises and can move limb against gravity for 8-10 reps W/O pain

Question 31

Functional Mobility (Therapeutic Exercises)

Answer 31

Walking - crucial to Wb and walk to increase bone density. improve muscle strength, and prevent contractures - Encourage standing, cruising, and walking at the expected ages - young children should walk within home, outside, and for short community distances

Question 32

Foot wear considerations

Answer 32

Sneakers with flexible soles, good arch support and deef heel cups LLD corrected with shoe lift Custim made orthotics; help improve pain, walking speed, and physical functioning especially for children with active ankle and foot arthritis

Question 33

Assistive devices

Answer 33

cane - for one leg pain Walkers may be necessary if significant bilateral lower limb impairments, with platform attachments if upperlimb mobility is limited

Question 34

Wheeled mobility

Answer 34

may need WC or scooters for long distances

Question 35

What to do at school

Answer 35

Impacts school performance: due to frequent ilness and medical attention required Decreased attentioon caused by pain, stiffness and fatigue

Question 36

What should PT do for school?

Answer 36

Inform school personnel about the imapct of JIA on school performance and suggest ADAPTATIONS

Question 37

What are some possible adaptations for school

Answer 37

- Second set of books for home - Adapted writing tools (decreased grip strength) - Laptop for notes - Easel-top desk for children with cervical spine arthritis - Modified schedules (visits to nurses) - Allowing children to move periodicallly - using elevator

Question 38

What can children do for sports and recreation

Answer 38

- LOW IMAPCT with arthritis in weight bearing - PE participation should be encouraged with therapist consultation for activity adaptations - avoid somersaults, headstands, and weightbearing on hands children with mild-to-moderate can participate in sport, but high impact in inflamed or swollen joints should be avoided - sports with collision should be discouraged - coaches should be informed about the child's diagnosis and safety considerations and allow occasional breaks during practice and games.