JIA - from 1st Lecture Flashcards
What is the most common chronic rheumatic disease of childhood?
• which sex is this typically seen in?
• Epidemiology?
Juvenile Ideopathic Arthritis is more common in females. This disease is about 3x as prevalent in Europe.
T or F: JIA is an inflammatory arthropathy.
True
How is someone likely to present with Oligoarticular JIA?
• how will this disease progress if you miss the diagonsis?
• Joints involved
Most often this will present to you as a female that has joint swelling in 4 joints or fewer. Unlike a septic joint these joints are not tender. Joint involvement will look the following way knees > ankles > LE small joints > UE joints
Children will stop using affected joints and the surrounding muscles will undergo atrophy and contracture.
What are the two types of polyarticular JIA?
• how do they differ?
I’m guessing criteria is 4 or more joints.
RhF - positive (more episodic)
• Episodes of arthritis on 2 or more occasions that are less than 3 mo. apart.
• Patients often have involvement of the hands and spine too. Spine nodules may be seen.
RhF - negative (more insideous like I’m here to stay)
• This disease is more insideous in onset with stiffness and gelling in the mornings.
• Knees, Wrists and Ankles are most often involved with possible TMJ and underdevelopment of mandible and involvment of the CERVICAL spine.
Which type of arthritis is shown on the right and the left?
Left:
RhF negative JIA with cervical spine and wrist invovlment
Right:
RhF positive JIA with spininal and hand involvement
What criteria do you look for to diagnose SYSTEMIC onset JIA?
• what disease is it often confused with? why?
Often confused with lupus due to symptoms like pleural effusions and rashes.
**Note a Quotidian fever is one that occurs everyday**
How will a Systemic JIA patient present?
These kids will present with arthritis that is preceeded by or occurs alongside a fever that is persistent for two weeks. It will also be accompanied by two or more of the following: erythematous rash accompanying the fever, hepatospendomegally, LAD, or serositis.
Macrophage Activating Syndrome:
• What disease is it associated with?
• what happens in this disease?
• Are males or females typically more affected?
MAS is associated with systemic onset JIA and occurs when the T lymphocyte population expanded and macrophages are activated to eat like everthing including neutrophils etc. Both males and females with SO JIA are affected equally.
What are drugs that may trigger Macrophage activating Syndrome?
Note that many of these drugs are the same ones we use to treat systemic onset JIA.
Drugs:
• NSAIDs
• Methotrexate
• Suphasalazine
• Etanercept
**viruses may also causes this
What indicators that your macrophages are hyperactivated?
How the labs of a patient with Systemic Onset JIA and one with MAS differ?
• key things to look at?
- In MAS you’ll see pancytopenia, especially decreased neutorphils accompanied by increases PT and PTT b/c they ate all the platelets
- Important markers are soluble CD25 and CD163 and CD156
• NOTE THE ESR will be lowered (b/c of less fibrinogen)
