JIA Flashcards
what is it?
Group of systemic inflammatory disorders affecting children below age of 16 years. The most commonly diagnosed Rheumatic disease in children. An important cause of disability and blindness. Autoimmune.
criteria for diagnosis
<16yo,
duration >6 weeks,
joint swelling or painful and limited joint motion, tenderness, warmth.
parents will describe stiff walking in the morning.
generally speaking who does JIA mainly effect
young females.
what are the 3 major subtypes
pauci/oligoarticular (3 types),
polyarticular (RF +ve or RF -ve),
(Still’s disease) systemic onset.
outline pauciarticular type 1,2 and 3 JIA
just read this card…
1 - majority of pauci, before 5yo, 8:1 girls:boys, limp rather than pain, mainly LL joints, knee>ankle>hand or elbow, +ANA in 40-75%, often chronic uveitis, and an irregular iris.
2 - age 8-9yo, 1:7 girls:boys, limp due to LL joint joints at knee and ankle, hip can be effected early and enthesis, many have sacroiliac joints and AS or spondyloarthritis. Acute iridocyclitis in 20%
3 - any age during childhood, 4:1 girls:boys, assymetric LL and UL arthritis, dactylitis, 40% have fhx of psoriasis, may be nail pitting, these patients may developo psoriasis later in life, chronic idocyclitis in 10-20%
outline RF -ve polyarticular JIA
outline RF +ve polyarticular JIA
just read…
outline RF -ve polyarticular JIA
any age, 9:1 girls:boys, low grade fever and malaise, hepato-splenomegaly,mild anaemia, growth abnormalities, symettrical large and small joint swelling (MCP, PIP, knees, wrists, ankles, neck), iridocyclitis rare.
outline RF +ve polyarticular JIA
late childhood (12-16yo), 7:1 girls:boys, low grade fever, malaise, weight loss, anaemia, nodules, similar to adult RA, erosions occur in xrays early, iridocyclitis is rare
Outline Systemic onset JIA
20% of JIA, (4-6yo), roughly same girls to boy prevelence, extra-articular features define the disease:
TRUNK/THIGHS HAVE SALMON RASH, FEVER, JOINT SWELLING, LYMPHADENOPATHY, HEPATOSPLENOMEGALY, ABDO PAIN, PAIN AND REDNESS and UVEITIS!
and polyserositis, pericarditis, pleural effusion, pulmonary fibrosis, Arthritis within 3-12 months onset of fever,
Uveitis in JIA
ANTERIOR UVEITIS - significantly related to patients with erly onset JIA and RF-ve JIA, JIA is the most common cause of non-infectious uveitis, can effect all JIA groups
what are the complications of uveitis in JIA?
posterior synehiae, cataract, band keratotherapy,
what non-articular features would also be present?
anaemia, anterior uveitis, evansecent rash, hepatosplenomegaly, lymphadenopathy
Tx for Uveitis
screening, steroids, methotrexate, MMF, cyclosporin, anti-TNF.
DDx for JIA
septic arthritis, RA, meniscal damage, trauma,
what is the Tx for JIA?
1st line - NSAIDs and local steroids
2nd line - Methotrexate,
3rd line - anti-TNF -infliximab.
4th line - IL-1 Receptor Antagonist - Anakinra. IL-6 Antagonist (Tocilizumab)
ALSO use physio and OT ALSO surgical (synovectomy, econstructive/ joint replacement surgery)
with physio they may grow out of the condition
when are systemic steroids used and what are the se’s?
systemic JIA, serious disease complications, children ongoing surgery. SE’s - osteoporosis, infections, growth abnormalities.
when are local steroids used?
intra-articular mainly in Oligo-articular JIA and used in eye diseases.
