June1 M1-Juvenile Idiopathic Arthritis Flashcards
criteria for JIA
- onset before 16
- arthritis for 6 weeks+
- exclude other causes of arthritis in children (post infectious process, malignancy, mechanical, etc.)
the difference diseases in JIA
- systemic arthritis
- oligoarthritis (<5 joints)
- polyarthritis RF-
- polyarthritis RF+ (RA like)
- psoriatic arthritis
- enthesitis related arthritis (ERA)
- undifferentiated arthritis
arthritis general definition
either of
- swelling OR effusion
- two or more of these: warmth, limited ROM, pain with ROM
why want to control inflammation as one of the tx goals in JIA
to avoid cartilage damage and joint damage
problem seen often in ROM in JIA
stiffen up and can’t flex or extend too much. often limited in doing flexion but extension is fine
how do you dx JIA
clinical (the labs are just to rule out other things)
(IMP) how useful are ANA (Antinuclear antigen) and rheumatoid factor (RF) as tests for dx JIA
ARE NOT DIAGNOSTIC
when do you do ANA in JIA
- pt with confirmed JIA (oligo or poly) and evaluate their uveitis risk (prognosis)
- pt you suspect to have a CTD (like lupus)
when do you do RF in JIA
- generally not useful in pediatrics
- pt with confirmed JIA (poly) and evaluate their risk of severe, erosive disease
XR use in JIA
- compare with other joint
- rule out other things
- but effusions are seen clinically
oligoarthritis (1-4 joints) typical presentation
- monoarthritis of the knee
- painless limp or swelling, insidious onset
- flexion contracture
ANA in oligo
is positive in 75-85% of patients
prognosis in oligo
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.
oligo on XR
- smaller joint space
- less bone density
- periarticular osteopenia
- larger patella
joint abnormalities on XR in JIA in general
- 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
charact of the uveitis that 20% develop in oligo
chronic anterior uveitis
- chronic non granulomatous inflammation of iris and ciliary body
- asymptomatic (need slit lamp)
- complications: synechiae, band keratopathy, catarct, glaucoma
why chronic anterior uveitis occurs in JIA (oligo)
Ab mediated molecular mimicry
oligoarthritis management
- NSAIDs
- intra-articular CS injection (if advanced bone maturation, flexion contracture)
- PT, OT
- regular eye exam**
polyarthritis JIA is what
JIA with arthritis to 5+ joints during the first 6 months of the disease
poly JIA RF- (poly-) typical presentation
- many joints, small and large involved
- morning stiffness
- TMJ*** (micrognathia)
- early functional incapacity
ANA in poly-
used for prognosis (determine risk of uveitis)
- normal risk (ANA - ) = 5-10%
- ANA+ = higher risk
XR of poly- JIA
- 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
poly- JIA one important test in the pGALS
prayer sign. if there is space between palms of hands = flexion contracture, or if the wrists are not touching
poly RF+ typical case
- small and large joints
- symmetrical + erosions
- similar to adult RA, rheumatoid nodules
- NO UVEITIS
- poorer prognosis (bc RF is positive)
polyarthritis RF+ or RF- what’s the management
- 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)
systemic arthritis JIA definition
- arthritis preceded with daily fever of 2 weeks+ (daily for at least 3 days)
- WITH 1+ of these: rash, lymphadenopathy, hepatomegaly or splenomegaly, serositis
systemic arthritis typical pres
- arthritis
- fever (symptoms worse with fever) with 1 spike per day
- rash
- anemia, high WBC and platelets, hypoalbuminemia, acute phase reactants
imp things about systemic arthritis
- uveitis is rare
- systemic arthritis can be life threatening*
systemic arthritis tx
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
juvenile psoriatic arthritis (JPA) def
either of:
- arthritis and psoriasis
- arthritis + 2 of: dactylitis (fingers and toes), nail abnormalities, FHx of psoriasis in 1+ first degree relatives
typical pres of JPA
- 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)
enthesitis related arthritis (ERA) definition
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
enthesitis definition
inflammation of the enthesis, which is where the tendon sheath inserts in bone
ERA related to what disease
may be a precursor for ankylosing spondylitis
ERA typical pres
- heel pain
- lower limb arthritis
- acute uveitis
- HLA B27+
JIAs affecting boys more
ERA
JIAs affecting girls more
- oligo
- poly RF+ and RF-
- JPA
JIAs affecting boys and girls equally
systemic arthritis
