JIA lecture Flashcards

1
Q

What do you need to make a diagnosis of JIA

A

S and S >6wks

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2
Q

What determines the disease subtype?

A

by disease presentation in 1st 6mn

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3
Q

What are the 6 subtypes of JIA

A

1) Oligoarticular
- asymmetrical large jts; 4 or less jts; uveitis asym & chronic 20-30; tendonitis; boney over/under growth
- peaks 1-3 yrs female > male
2) Polyarticular
- 1-3 and 9-12; female > male; 5 jts or more; symmetrical jare ange small jts ; asym uveitis; systemic signs possible; RF+ tendon nodules involved
3) Systemic
- any age; female = male; jts variable; asympt and rare uveitis; systemic signs always positive; generlized growth retardation
4) Psoriatic
5) Enthesitis related (ESR)
- only condition where uveitis is symptomatic 10-20%

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4
Q

What is the key symptom of JIA that needs to be checked all the time and is usally asympt. ?

A

Uveitis inflame to the chambers of the eyes

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5
Q

WHat are 8 S and S of JIA?

A

1) Pain
2) decrased ROM
3) AM stiffness
4) fatigue
5) decrased function
6) asymt. posture
7) restricted muscle length and strength
8) Growth abnom.

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6
Q

Where does it effect?

A
  • jt synovium
  • tendon sheath synovium
  • Entheses (tendon bone jt) esp feet

(** really impt to have a multidis. team with child centre focus**)

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7
Q

What is the goal of Rx?

A

decrease impact of disease so that the child can function as physically, socially and emotoinally as normal now and throughout life

  • OT - more global well being soical interven (teach pain management and coping)
  • PT - Body function: releive pain and stiffness; incrase joint ROM
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8
Q

What are the key comp. to Ax

A

1) Observation:

  • get baseline; have they gone from walking back to crawling; ski booting; growth implications
  • jt count (jt swelling OR limitaiotn of motion with heat, over presure pain or jt line tenderness)

2) Pain Ax

  • P c/cout inflam - will impact childs life; need to get good understanding of pain (where/when/ how much…how often) child may not disclose infront of parents
  • PAIN MANAGMENT: educ. meds, positions, modalities, jt protect (how swollen = ice; stiff = heat)

3) ROM Ax

  • hypermobility will be there; take serial measurements; gonio; comp movt patterns
  • 5 tests: thumbs to foreams, fingers parallel; hyperext of elbow and knees; palm to floor)
  • DONt measure things that can change with growth like side flexion in standing

4) Mobility and strength

  • isometric, encourage child to full effort
  • common jt problems –> limited neck ext; flex PIP; TMJ NOT common

** most common knees (2-4)

  • toe walking

5) Fatigue

  • what patterns have changed

_** >6wks + napping = RED FLAG **_

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9
Q

What are the casues of fatigue ?

A
  • active disease
  • poor sleep
  • uncontrolled P
  • Decondition
  • depression
  • abnormal movt patterns
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10
Q

How should kids manage fatigue

A

* control the pain + good goals achievable

  • imporve msucle strength and movt patterns
  • sleep hygiene ; take bus dont walk…
  • keep journals not always good b/c thenthey are focusing on it ; good ergo
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11
Q

What is a good Ax tool?

A

Gait

  • tells you about functional limiations (energy, foot wear…) and restirctions (ROM/strength and muscle length)
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12
Q

How do you presecribe exs for JIA?

A
  • prescribe based on acuity (acute, sub vs chronic) not all jts at the same degree at same time
  • more chronic disease give more reactive, balance work

- **REMEMBER TO THINK OF TIMES WHEN CAPSULE WILL BE OVER STRETCHED - this will cause jt to be unstable**

  • need to consider aherence, not too many and do they have family support are there family obligations
  • attention span
  • make therapy playful, adapt therapy so they dont have to adapt their life
  • remind them that b/c one thing is limited one day does not mean they have to cut it out it oculd just be that day .. try it again later on
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13
Q

What are 2 activities that are good for JIA

A

Swimming and biking

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14
Q

What are 3 Rx adaptations and implementations?

A

1) serial cast
- Knees, wrist, elbows b/c of persistant fucntional loss (do it post cortico injection)

GOAL; functional ROM in new ROM & strengthen up to 3yrs post casting

2) Modify ADL’s and footwear

  • educ, energy conservation, modalities (when to use heat and cold)
  • larger gripped objects
  • ORthotics: 3D’s is gold stnd. impt to k onw if wearing right correctly

(plastic part behind MTP NOT PAST THE JT)***

3) Adapt/inform school

  • consider doc apts, fatigue, P, depression
  • encourage Lesure b/c thats the first to go most times

** always want to think about childs transition –> 18yrs to mary pack or case manager, encourage good support network, like going to camps (this is very impt for physical, emotional and social support) - role models - how do they live with it?!

  • get to know the specifics of what they like
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15
Q

NOTES:

A

if you had pt centered care from the beginning it should make the tranisition easier

  • gain their trust and respect
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16
Q

What kind of disease is JIA; what do you have to consider about the growth plates?

A
  • autoimmune disease
  • depending on when it starts - the effected limb could be longer b/c the inflam process will speed up the area,
  • in adolescence then effected side shorter b/c the plate closes early and fuses ( esp during puberty)

impt to consider age!!!