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MSK II > JIA > Flashcards

JIA Flashcards

1
Q

Dx of JIA

A

6wks

exlcusion of other forms of juvenile arthritis

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2
Q

types of JIA onset

A

polyarthritis
pauciarthritis
systemic disease

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3
Q

JIA differential Dx

A 
SLE
reactive arthritis
Lyme
dermatomyositis
kawasaki (rash)
Rheumatic fever
IBS
hematologic
vasculitis
septic arthritis
toxic synovitis of hip
neoplasia
infantile-onset multi-systemic inflammatory disease
psychogenic
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4
Q

systemic onset

A

10-15%
1 or > joints
extra-articular features >6wks

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5
Q

pauciarticular onset

A 
usually oligo
50%+
subtype I- classic
subtype II- spondylitic
subtype III- psoriatic
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6
Q

polyarticular onset

A

30-40%
RF pos
or
RF neg

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7
Q

growing pains

A 
6-13yrs
lower extremities
pain usually in thighs, calves, shins, not joints
most frequent at night
correlated with strenuous exertion
normal growth and development
heat, massage, analgesics
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8
Q

systemic JIA aka

A

stills disease

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9
Q

systemic JIA signs and symptoms

A

malaise, fever (irregular), rash, adenopathy, hepatosplenomeglay, serositis, hepatitis, DIC, anemia

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10
Q

systemic JIA MSK symptoms

A

arthritis, myalgia, arthralgias, symmetrical swelling

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11
Q

systemic JIA age of onset

A

usually 5 usually female

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12
Q

JIA rash

A 
evanescent and intermittent
salmon pink
circumscribes macular
2-6mm, confluence common
chest, axilla, thighs, upper arms
pruitis unusual
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13
Q

systemic JIA labs

A

ERS high
CBC: anemia, leukocytosis, thrombocytosis
IgM RF- neg
ANA- neg

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14
Q

systemic disease course and prognosis

A

younger age of onset > risk poor health
1/2 will have recurrent episodes
1/3 have progressive arthritis
amyloidosis can occur

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15
Q

management of systemic JIA

A 
splinting to prevent deformity
PT and OT
NSAIDs
corticosteroids if severe
DMARDs?
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16
Q

pacuiarticular disease subtype I

A

M

most common type

17
Q

clinical features of pacuiarticular subtype I

A

joints <5 (knee, ankle, elbow, hip)
early growth abnormalities
chronic uveitis w/in 5 years (asymptomatic) - must send these kids to have eyes checked yearly

18
Q

uveitis

A

flame hemorrhages
must be screened yearly
occurs in 30% of pts

19
Q

labs of pacuiarticular subtype I

A 
ESR- increased or normal
CBC: normal
RF-neg
ANA- can be +
HLAA2, DR5, DRw6, and DRw8
20
Q

course and prognosis of of pacuiarticular subtype I

A

early detection and management important
exacerbations and remissions
long-term prognosis of joints good
complications: alteration of growth, iridocyclitis (blind)

21
Q

management of pacuiarticular subtype I

A 
splint
PT and OT
NSAIDS
corticosteroid injections controversial
frequent ophthalmologic assesment
22
Q

pauciarticular disease subtype II aka

A

juvenile spondylarthropathy

23
Q

clinical pauciarticular disease subtype II

A 
>9
M>F
periphearl arthritis LL
enthesopathies
acute iritis 
SI pain in some
Axial pain in some
24
Q

labs pauciarticular disease subtype II

A

ESR- normal-high
CBC- normal
RF- neg
HLA-B27

25
Q

course and prognosis pauciarticular disease subtype II

A

fnx outcome good in 2/3

1/3 my develop spondylitis, hip, and cervical problems

26
Q

Tx pauciarticular disease subtype II

A 
PT and OT
posture training
NSAIDs
Anti-TNF?
local corticosteroid injections
hip arthroplasty
OPTHALMOLOGIC exams
27
Q

pauciarticular disease subtype III aka

A

psoriatic

28
Q

clinical pauciarticular disease subtype III

A 
8
F>M
FHx of psoriasis
rarely systemic
occasionally severe destructive arthritis
dactylitis
asymmetric peripheral joints
psoriatic rash, nail pitting, oncholysis
flexor tenosynovitis
29
Q

labs pauciarticular disease subtype III

A

ESR- varies with # of joints
CBC: anemia, WBC can be high or low
RF neg
ANA- can be pos, not alwasy

30
Q

course and prognosis pauciarticular disease subtype III

A

young onset associated with iritis
remitting and relapsing, even into adulthood
occasionally severely destructive
occasionally spondylitis develops

31
Q

Tx pauciarticular disease subtype III

A 
PT and OT
splinting
NSAIDs
MTX
anti-TNF
32
Q

clinical polyarticular JRA RF neg

A 
any age, F>M
can affect any joint
reduced neck and TMJ ROM
flexor tenosynovitis 
\+/- fever
mild lymphadenopathy and hepatosplenomegaly
33
Q

labs polyarticular JRA RF neg

A

ESR- increased
CBC- anemia, mild leukocytosis, thrombocytosis
RF- neg
ANA- occasionally pos

34
Q

course and prognosis polyarticular JRA RF neg

A

variable
may be monocyclic, but prolonged with good fnx outcome
recurrent episodes tend to cause progressive deformities

35
Q

Tx polyarticular JRA RF neg

A 
splinting
PT/OT
NSAIDs
DMARDs
anti-TNF
36
Q

clinical polyarticular JRA RF pos

A 
>8
F>M
polyarthritis of any joint (usually small joints first)
arthritic malformations
cervical subluxation 
rheumatoid nodules
vasculitis- uncommon and late
37
Q

labs polyarticular JRA RF pos

A 
ESR-increased
CBC- anemic
RF-post, high titer
ANA- may be pos
HLA-DR4
x-rays
38
Q

course and prognosis polyarticular JRA RF pos

A

persistent- serious joint destruction and poor fnx
additional long-term hazards: C1-C2 subluxation
aortic insufficiency and amyloidosis

39
Q

Tx polyarticular JRA RF pos

A 
splinting
PT/OT
NSAIDs
DMARDs (MTX)
anti-TNF
surgery

MSK II (19 decks)

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