Juvenile Arthritis Flashcards
Juvenile Arthritis Synonyms:
Juvenile Rheumatoid Arthritis (JRA) = USA
Juvenile Chronic Arthritis (JCA)= Europe
Juvenile Idiopathic Arthritis (JIA)= International League of Rheumatology
CHILDHOOD ARTHRITIS IS NOT
A HOMOGENIOUS ENTITY
THERE IS NO SINGLE BEST Characteristic Appearance Diagnostic Criterion Treatment Uniform prognosis
CHILDREN WHO DO NOT FIT INTO ANY CATEGORY SHOULD BE REFERRED TO AS HAVING JUVINILE ARTHRITIS.
HOT JOINTS BY THE NUMBERS
Pauci <5 joints
- Mono-arthritis 1 joint
- Oligo 2-4 joints
Extended Pauci 5-6 joints
Poly 6+ joints
So what do you mean by “Hot Joints” in Kids?
Any swelling or effusion, increased warmth, and/or painful limited movement with or without tenderness in one or more joints lasting more than 6 weeks.
Demographics
Onset usually under 9 Years of age
Incidence: From 1/1000 up to
12-20 /100,000
30 - 50,000 children in the U.S.
ACR Classification Criteria for the Diagnosis of JIA
Age at onset < 17 years
Arthritis in 1 or more joints
Duration of disease > 6 weeks
Type of onset of disease during the first 6 mos
- Polyarthritis
- Pauciarthritis
- Systemic Disease- (= Still’s)
Exclusion of other forms of juvenile arthritis
JIA - Differential Diagnosis
SLE Reactive Arthritis Lyme Disease Dermatomyositis Kawasaki Disease Rheumatic Fever Inflammatory Bowel Dx Hematologic Dx Vasculitis Septic Arthritis Toxic Synovitis of Hip Neoplasia Infantile-onset multi-systemic inflammatory disease Psychogenic Disease
kids with limps are what until proven otherwise?
leukemia
JIA: Subtype Classification
Systemic Onset (Still’s disease)
- 1 or > joints involved
- extra-articular features > 6 weeks
Pauciarticular (Oligoarticular) (50%+)
- Subtype I: Classic
- Subtype II: Spondylitic
- Subtype III: Psoriatic
Polyarticular (30 – 40%)
- Rheumatoid Factor (RF) Positive
- RF Negative
Characteristics of Growing Pains
Age: 6-13 yrs of age
Distribution: Lower extremities
- Pain localized to thighs, calves & shins (not joints)
Pain most frequent late in day or night (not morning)
Correlation with strenuous exertion is variable
Normal growth & development
Treatment: heat, massage & analgesics
Systemic JIA: Major Features
can be with just one joint involved
- Systemic Signs & Symptoms
Malaise, fever, rash, adenopathy, hepatosplenomegaly, serositis, hepatitis, DIC, anemia - Musculoskeletal Symptoms
Arthritis, myalgia, arthralgias - Age of Onset
Usually under 5 yoa
If under 5 yoa F=M
If > 5yoa F>M
JIA Rash
Evanescent (transient) and intermittent Salmon pink Circumscribed macular Size: 2-6 mm or greater - Often confluent
Distribution:
- Chest
- Axilla
- thighs & upper arms
Pruritis unusual
Systemic Disease Investigations
ESR - high CBC - Anemia - Leukocytosis (inc. polys - Thrombocytosis IgM RF - neg ANA - neg
Systemic Disease Course and Prognosis
- Younger age of onset > risk of poor health
somatic and joints
1/2 will have recurrent episodes
1/3 have progressive arthritis
Amyloidosis occurs in some children with persistent disease activity
Systemic Disease Management:
Splinting to prevent deformity Physical and Occupational Therapy NSAID - pain, fever & inflammation Corticosteroids - in severe cases DMARDs - ? benefit