JIA

Question 1

Dx of JIA

Answer 1

6wks

exlcusion of other forms of juvenile arthritis

Question 2

types of JIA onset

Answer 2

polyarthritis
pauciarthritis
systemic disease

Question 3

JIA differential Dx

Answer 3

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

Question 4

systemic onset

Answer 4

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

Question 5

pauciarticular onset

Answer 5

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

Question 6

polyarticular onset

Answer 6

30-40%
RF pos
or
RF neg

Question 7

growing pains

Answer 7

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

Question 8

systemic JIA aka

Answer 8

stills disease

Question 9

systemic JIA signs and symptoms

Answer 9

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

Question 10

systemic JIA MSK symptoms

Answer 10

arthritis, myalgia, arthralgias, symmetrical swelling

Question 11

systemic JIA age of onset

Answer 11

usually 5 usually female

Question 12

JIA rash

Answer 12

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

Question 13

systemic JIA labs

Answer 13

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

Question 14

systemic disease course and prognosis

Answer 14

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

Question 15

management of systemic JIA

Answer 15

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

Question 16

pacuiarticular disease subtype I

Answer 16

M

most common type

Question 17

clinical features of pacuiarticular subtype I

Answer 17

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

Question 18

uveitis

Answer 18

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

Question 19

labs of pacuiarticular subtype I

Answer 19

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

Question 20

course and prognosis of of pacuiarticular subtype I

Answer 20

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

Question 21

management of pacuiarticular subtype I

Answer 21

splint
PT and OT
NSAIDS
corticosteroid injections controversial
frequent ophthalmologic assesment

Question 22

pauciarticular disease subtype II aka

Answer 22

juvenile spondylarthropathy

Question 23

clinical pauciarticular disease subtype II

Answer 23

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

Question 24

labs pauciarticular disease subtype II

Answer 24

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

Question 25

course and prognosis pauciarticular disease subtype II

Answer 25

fnx outcome good in 2/3 | 1/3 my develop spondylitis, hip, and cervical problems

Question 26

Tx pauciarticular disease subtype II

Answer 26

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

Question 27

pauciarticular disease subtype III aka

Answer 27

psoriatic

Question 28

clinical pauciarticular disease subtype III

Answer 28

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

Question 29

labs pauciarticular disease subtype III

Answer 29

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

Question 30

course and prognosis pauciarticular disease subtype III

Answer 30

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

Question 31

Tx pauciarticular disease subtype III

Answer 31

``` PT and OT splinting NSAIDs MTX anti-TNF ```

Question 32

clinical polyarticular JRA RF neg

Answer 32

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

Question 33

labs polyarticular JRA RF neg

Answer 33

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

Question 34

course and prognosis polyarticular JRA RF neg

Answer 34

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

Question 35

Tx polyarticular JRA RF neg

Answer 35

``` splinting PT/OT NSAIDs DMARDs anti-TNF ```

Question 36

clinical polyarticular JRA RF pos

Answer 36

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

Question 37

labs polyarticular JRA RF pos

Answer 37

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

Question 38

course and prognosis polyarticular JRA RF pos

Answer 38

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

Question 39

Tx polyarticular JRA RF pos

Answer 39

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