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Bloc H - Movement > June1 M1-Juvenile Idiopathic Arthritis > Flashcards

June1 M1-Juvenile Idiopathic Arthritis Flashcards

1
Q

criteria for JIA

A
  • onset before 16
  • arthritis for 6 weeks+
  • exclude other causes of arthritis in children (post infectious process, malignancy, mechanical, etc.)
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2
Q

the difference diseases in JIA

A
  • systemic arthritis
  • oligoarthritis (<5 joints)
  • polyarthritis RF-
  • polyarthritis RF+ (RA like)
  • psoriatic arthritis
  • enthesitis related arthritis (ERA)
  • undifferentiated arthritis
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3
Q

arthritis general definition

A

either of

  • swelling OR effusion
  • two or more of these: warmth, limited ROM, pain with ROM
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4
Q

why want to control inflammation as one of the tx goals in JIA

A

to avoid cartilage damage and joint damage

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5
Q

problem seen often in ROM in JIA

A

stiffen up and can’t flex or extend too much. often limited in doing flexion but extension is fine

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6
Q

how do you dx JIA

A

clinical (the labs are just to rule out other things)

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7
Q

(IMP) how useful are ANA (Antinuclear antigen) and rheumatoid factor (RF) as tests for dx JIA

A

ARE NOT DIAGNOSTIC

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8
Q

when do you do ANA in JIA

A
  • pt with confirmed JIA (oligo or poly) and evaluate their uveitis risk (prognosis)
  • pt you suspect to have a CTD (like lupus)
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9
Q

when do you do RF in JIA

A
  • generally not useful in pediatrics

- pt with confirmed JIA (poly) and evaluate their risk of severe, erosive disease

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10
Q

XR use in JIA

A
  • compare with other joint
  • rule out other things
  • but effusions are seen clinically
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11
Q

oligoarthritis (1-4 joints) typical presentation

A
  • monoarthritis of the knee
  • painless limp or swelling, insidious onset
  • flexion contracture
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12
Q

ANA in oligo

A

is positive in 75-85% of patients

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13
Q

prognosis in oligo

A

20% of pts get a related uveitis. completely unrelated to the oligo. may be able to tx any of the two and not the other, or both.

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14
Q

oligo on XR

A
  • smaller joint space
  • less bone density
  • periarticular osteopenia
  • larger patella
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15
Q

joint abnormalities on XR in JIA in general

A
  • joint effusion + increase in soft tissues
  • advanced bone maturation (enlarged epiphyses, bony overgrowth)
  • periarticular osteopenia
  • loss of joint space, erosions
  • C spine fusion of vertebral spinous processes C2-C3
  • TMJ flattening of mandibular condyle and shortening of the mandible
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16
Q

charact of the uveitis that 20% develop in oligo

A

chronic anterior uveitis

  • chronic non granulomatous inflammation of iris and ciliary body
  • asymptomatic (need slit lamp)
  • complications: synechiae, band keratopathy, catarct, glaucoma
17
Q

why chronic anterior uveitis occurs in JIA (oligo)

A

Ab mediated molecular mimicry

18
Q

oligoarthritis management

A
  • NSAIDs
  • intra-articular CS injection (if advanced bone maturation, flexion contracture)
  • PT, OT
  • regular eye exam**
19
Q

polyarthritis JIA is what

A

JIA with arthritis to 5+ joints during the first 6 months of the disease

20
Q

poly JIA RF- (poly-) typical presentation

A
  • many joints, small and large involved
  • morning stiffness
  • TMJ*** (micrognathia)
  • early functional incapacity
21
Q

ANA in poly-

A

used for prognosis (determine risk of uveitis)

  • normal risk (ANA - ) = 5-10%
  • ANA+ = higher risk
22
Q

XR of poly- JIA

A
  • advanced bone maturation (enlarged epiphyses, bony overgrowth)
  • periarticular osteopenia
  • reduced joint space
  • C spine involvement possible, lose extension (lose space between spinous processes, C2-C3-C4 fuse
23
Q

poly- JIA one important test in the pGALS

A

prayer sign. if there is space between palms of hands = flexion contracture, or if the wrists are not touching

24
Q

poly RF+ typical case

A
  • small and large joints
  • symmetrical + erosions
  • similar to adult RA, rheumatoid nodules
  • NO UVEITIS
  • poorer prognosis (bc RF is positive)
25
Q

polyarthritis RF+ or RF- what’s the management

A
  • NSAIDs (like oligo)
  • DMARDs (methotrexate, sulfasalazine, hydroxycholoriquine, leflunomide) (add this, didn’t have it in oligo)
  • intra-articular CS injections (like oligo)
  • biologics (anti-TNF. didn’t have this in oligo)
  • PT, OT (as in oligo)
  • regular eye exam for RF- (as in oligo)
26
Q

systemic arthritis JIA definition

A
  • arthritis preceded with daily fever of 2 weeks+ (daily for at least 3 days)
  • WITH 1+ of these: rash, lymphadenopathy, hepatomegaly or splenomegaly, serositis
27
Q

systemic arthritis typical pres

A
  • arthritis
  • fever (symptoms worse with fever) with 1 spike per day
  • rash
  • anemia, high WBC and platelets, hypoalbuminemia, acute phase reactants
28
Q

imp things about systemic arthritis

A
  • uveitis is rare

- systemic arthritis can be life threatening*

29
Q

systemic arthritis tx

A

like polyarthritis JIA but add close follow up of systems + systemic steroids on top of

  • NSAIDs
  • second line (DMARDs, etc.)
  • biologics
  • intra-articular CS
  • PT, OT
30
Q

juvenile psoriatic arthritis (JPA) def

A

either of:

  • arthritis and psoriasis
  • arthritis + 2 of: dactylitis (fingers and toes), nail abnormalities, FHx of psoriasis in 1+ first degree relatives
31
Q

typical pres of JPA

A
  • small and large joints
  • girl any age
  • oligarthritis (1-4 joints) or asymmetrical poly
  • nail pitting, dactylitis
  • maybe psoriasis
  • spinal or sacroiliac joint involvement
  • FHx
  • chronic uveitis (asymptomatic) much more common than acute uveitis (red painful eyes)
32
Q

enthesitis related arthritis (ERA) definition

A

either of

  • arthritis + enthesitis
  • arthritis + 2+ of these: arthritis in boy after 6 yo, acute anterior uveitis, SI joint tenderness or inflam spine pain, HLAB27, FHx of HLA B27 disease in 1+ first degree relatives
33
Q

enthesitis definition

A

inflammation of the enthesis, which is where the tendon sheath inserts in bone

34
Q

ERA related to what disease

A

may be a precursor for ankylosing spondylitis

35
Q

ERA typical pres

A
  • heel pain
  • lower limb arthritis
  • acute uveitis
  • HLA B27+
36
Q

JIAs affecting boys more

A

ERA

37
Q

JIAs affecting girls more

A
  • oligo
  • poly RF+ and RF-
  • JPA
38
Q

JIAs affecting boys and girls equally

A

systemic arthritis

Bloc H - Movement (48 decks)

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