JIA Flashcards
Diagnosis by ARA
Onset before 16
Sx must persist min 6 weeks
Arthritis in 1 or more joints (defined as swelling within a joint or limitation in the ROM with joint pain or tenderness)
Exclusion of other diseases
Etiology
Autoimmune, multifactorial inheritance (genetics + environmental trigger), involvement of T-cells & HLA genes
Is there a lab test to diagnose JIA?
No.
When does a child get assigned to a subtype?
After 6 mo of active disease
What are the 7 subtypes?
Oligoarticular persistent and extended Seronegative Polyarticular Seropositive Polyarticular Systemic Psoriatric Enthesitis Undifferentiated
How many joints are affected in Oligoarticular JIA
4 or fewer (50% have only 1)
What joints are often affected with Oligoarticular JIA?
KNEE, ankle, wrist (often asymmetric joint involvement)
What is the most common kind of JIA?
Oligoarticular JIA
What other condition is common with Oligoarticular JIA?
Iridocyclitis (anterior uveitis) - may be asymptomatic
What is Persistent Oligoarticular JIA?
Affects no more than 4 joints throughout the course of the disease
What is Extended Oligoarticular JIA?
Affects more than 4 joints after the first 6 mo of the disease
How many joints need to be affected to be considered Polyarticular JIA?
5 or more joints
What joints are affected in Polyarticular JIA?
Knees, ankles, elbows, wrists, cervical spine and TMJ
What are the subtypes of Polyarticular JIA?
Seronegative (RF-) & Seropositive (RF+)
Peak ages and type of joint involvement in Seronegative Polyarticular JIA
2-4 & 6-12 y.o.
ASYMMETRIC
Peak ages and type of joint involvement in Seropositive Polyarticular JIA
Girls in late childhood/early adolescence.
SYMMETRIC - similar to adult RA
(wrists/small joints in hands/feet)
Severe constitutional symptoms of Systemic JIA
High Spiking fever Salmon colored rash (tunk/proximal extremities) Hepatosplenomegaly Pleuritis Pericarditis Lymphadenopathy
What is the life threatening syndrome associated with Systemic JIA?
MAS (macrophage activation system) - activation of T cells and macrophages leads to overwhelming inflammatory response
When does joint pain develop with Systemic JIA?
Later in the process. 25-50% develop significant joint destruction
Common clinical manifestations
Morning "gelling"/after immobility IL-1 & tumor necrosis factor alpha (mediates joint damage) Pannus formation Ligamentous Laxity Decreased ROM Dec Physical Activity/Weakness Osteopenia Growth disturbance Micrognathia
Medical Treatment
NSAID DMARDS (methotrexate) Anti-malarial (Plaquenil) Gold Salts Corticosteroids Biologic Agents
Methotrexate
Gold standard, Treats all types except systemic
What is inactive disease?
No joints with active arthritis No fever, rash, serositis No active uveitis/eye inflammation Normal CRP and ESR No disease activity on physician global assessment of disease activity
What is clinical remission on medication?
criteria for inactive disease are met for a minimum of 6 continuous months while on meds
What is clinical remission off medication?
criteria for inactive disease are met for a minimum of 12 continuous months off meds
Whats one of the first things a parent might notice with JIA?
Decreased activity, not wanting to play etc (d/t pain)
Pediatric pain scales
NIPS - babies FLACC- birth+, developmentally delayed (excluding paralyzed or those with spasticity) Oucher - ages 3 to 12 Faces Pain Rating Scale VAS COMFORT - unconscious/ventilator
What should you assess with a child with JIA?
The joint (look, feel, move, test) ROM Muscle strength (Observation of functional skills, MMT, handheld dynamometer) Posture/gait Functional abilities Physical Fitness
What is the PEDI-CAT?
Computer Adaptive Test. 3 functional domains & responsibility domain (daily activities, mobility, social-cognitive)
What is age range for the Wee-FIM?
6 mo - 7 years
may be used with children above 7 as long as their functional abilities (as measured by wee fim) are below those expected of children aged 7 who do not have disabilities
How many items and what domains are on the wee-fim
18 items, Self care, mobility, cognition.
What are the FIM levels?
No Helper
7 Complete Independence (timely, safe)
6 Modified ind (device)
Helper - Modified Dependence
5 Supervision (subject = 100%)
4 Minimal assistance (subject = 75% or more)
3 Moderate assistance (subject = 50% or more)
Helper - Complete Dependence
2 Maximal assistance (subject = 25% or more)
1 Total assistance (subject = less than 25%)
Juvenile Arthritis Assessment Scale age range
7-16 y.o.
What does Juvenile Arthritis Assessment Scale observe?
the child’s actual performance of typical activities under standardized conditions.
10 items - ADLs (dressing, picking up an object off the floor)
What is teh Juvenile Arthritis Assessment Scale scale?
0= task performed in less than or equal to criterion time 1= task performed in more time than the criterion time 2= unable to do the task
Activities Scale for Kids (ASK) age range
5-15 years old
What does ASK measure?
Measures physical disability and monitors functional change in children with limitations due to musculoskeletal disorders
How many items are on ASK
30 items - scored 0-4
What is the ASK scale?
0-4.
0 is with no problem and 4 is the child could not
(personal care, dressing, locomotion, play, standing, transfers, other skills)
Physical Fitness in pts with JIA
Peak oxygen uptake reduced in comparison to healthy peers
Lower peak work rate, peak exercise HR and exercise time
Impaired aerobic capacity appears to be related to hypoactivity more so than the severity of the disease
Recommendations for physical fitness in pts with JIA
2X/week
Moderate to vigorous intensity (60-85%max HR) for 45-60 minutes for at least 6-12 weeks
Tx of acute active joint swelling: AROM
go to point of discomfort and hold
10 reps 2-3x day
Proper hand placement to isolate the joint without stressing other joints
Tx of acute active joint swelling: isometric exercises
Submax contraction for 6 seconds for 5-6 reps
Tx of acute active joint swelling: other
Pain management, splinting/casting, activity modification
Tx: resolving joint inflammation
Progress home program
Antigravity activities
May add light resistance 8-10 reps against gravity without pain (TB, etc)
Aquatic therapy
Strengthening (observe joint protection principles)
Return to activity (consider appropriateness of activities)
Continue ROM exercises
