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Clin Med 3-2017 > Juvenile Arthritis > Flashcards

Juvenile Arthritis Flashcards

1
Q

Which type of Pauciarticular JIA is ANA positive and prevalent in young girls?

A

Type I

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2
Q

For Polyarticular JIA, which type of patient would have a positive RF?

A

Older children

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3
Q

For Polyarticular JIA, which type of patient would have a negative RF?

A

Younger children

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4
Q

For Polyarticular JIA, which type of patient would have a negative RF?

A

Younger children

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5
Q

T/F: Children exposed to antibiotics are at higher risk for juvenile arthritis

A

True

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6
Q

Describe the classification criteria of JIA?

A

-Age: < 16

  • Arthritis in one or more joints defined as swelling or effusion, OR:
  • -presence of two or more of:
  • ROM limitation
  • tenderness or pain on motion
  • increased heat
  • Duration of disease › 6 weeks
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7
Q

A patient is complaining about 5 or more joints–what type of JIA is this?

A

Polyarthritis

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8
Q

A patient is complaining about 4 or less joints–what type of JIA is this?

A

Pauciarticular (oligoarthritis)

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9
Q

A patient comes in with an intermittent fever and JIA, what type is this?

A

Systemic disease

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10
Q

What is the most common type of JA?

A

Pauci/Oligo (60%)

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11
Q

A mother brings in her twins: 6 year old girl and boy. They have fever, rash, hepatosplenomegaly, lymphadenopathy, serositis, and what seems to be arthritis symptoms. You feel their chests and think they might also have pericarditis. What is the first thing you should do?

A

Rule out: infection, leukemia

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12
Q

A mother brings in her twins: 6 year old girl and boy. They have fever, rash, hepatosplenomegaly, lymphadenopathy, serositis, and what seems to be arthritis symptoms. You feel their chests and think they might also have pericarditis. What laboratory data is consistent with systemic arthritis?

A
  • High ESR (and other acute phase reactants)
  • Leukocytosis
  • RF negative
  • ANA negative
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13
Q

A mother brings in her 6 year old child who has had a strange fever that comes and goes. It comes at the same time every day. What is this called? And what is it specific for?

A
  • Quotidian fever

- very specific for JIA

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14
Q

Explain the Koebner phenomenon.

A

The rash appears to follow the stroke of the scratch

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15
Q

What are some severe complications a patient can get with systemic arthritis?

A
  • severe polyarthritis
  • Pericarditis
  • Macrophage activation syndrome
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16
Q

A JIA patient is brought into the ER with a high fever, bleeding, HS-megaly, rash, jaundice, and lymphadenopathy. What could have triggered this?

A
  • varicella
  • Hep A
  • EBV
  • coxsakie B
  • gold
  • ASA
  • NSAIDS
  • MTX
  • sulfasalazine
  • penicillamine
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17
Q

T/F: In systemic arthritis, there is no:

  • Severe growth retardation
  • Delay in sexual maturation
A

FALSE: there is!!!

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18
Q

A JIA patient is brought into the ER with a high fever, bleeding, HS-megaly, rash, jaundice, and lymphadenopathy. Her lab results reveal:
-anemia
-leukopenia
-thrombocytopenia
-low fibrinogen
You have a hunch that she is suffering from Macrophage activation syndrome. What other lab result would be diagnostic to solidify your hunch?

A

Bone marrow is diagnostic

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19
Q

A JIA patient is brought into the ER with a high fever, bleeding, HS-megaly, rash, jaundice, and lymphadenopathy. What lab results should you order?

A
  • anemia
  • leukopenia
  • thrombocytopenia
  • low fibrinogin
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20
Q

A JIA patient is brought into the ER with a high fever, bleeding, HS-megaly, rash, jaundice, and lymphadenopathy. Her lab results reveal:
-anemia
-leukopenia
-thrombocytopenia
-low fibrinogen
What treatment might be effective for this patient?

A
  • Steroids

- Cyclosporin A

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21
Q

Oligoarthritis:

Boy: Girl ?
ANA: ?
RF: ?
Area most commonly affected: ?

A
  • 5 girls : 1 boy
  • ANA: +
  • RF: -
  • usually affects the knees and ankles
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22
Q

A patient is diagnosed with Oligoarthritis, but no more than 4 joints are affected throughout the disease course–what type is this?

A

Oligo-persistent

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23
Q

A patient is diagnosed with Oligoarthritis, but more than 4 joints were affected after the first 6 months of disease. What type is this?

A

Oligo-extended

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24
Q

Oligoarthritis is known for having a good outcome, but what are some of its common effects on the body?

A
  • sometimes growth inequality

- May progress to polyarticular disease manifested by hip involvement

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25
Q

What exam/test could be done to examine uveitis in JIA? How does it work?

A
  • Slit lamp exam

- detects anterior chamber inflammation

26
Q

What type of patient is at risk for JIA Uveitis?

A
  • Girls
  • onset before age 7
  • ANA +
27
Q

Because there is no warning for this specific condition, you should always screen for it in JIA patients–what is it?

A

Uveitis

28
Q

A mother brings in her 6 year old girl, who was diagnosed with JIA last year. You screen her for uveitis and find intraocular inflammation affecting the iris and ciliary body. What do you prescribe her?

A
  • topical steroids
  • SQ Methotrexate
  • IV Remade
  • SQ Humira and Enbrel

*highest risk for uveitis is w/in 2 years of onset of JIA

29
Q

When do most patients develop uveitis?

A

Within 5-7 years after the onset of their JIA

30
Q

T/F: Polyartheritis patients can either be RF + or RF -

A

True

  • 75% are RF -
  • 25% are RF +
31
Q

Describe the demographics of Polyarthritis patients if they are RF -

Age: ?
Sex: ?
ANA: ?
Other sxs: ?

A
  • 2-16 years
  • girls
  • 25% ANA (+)

Other:
-10-20% severe arthritis

32
Q

Describe the demographics of Polyarthritis patients if they are RF +

Age: ?
Sex: ?
ANA: ?
Other sxs: ?

A
  • 8-16 years
  • girls
  • 50% ANA

Other:

  • 50% severe arthritis
  • rheumatoid nodules
  • vasculitis
  • HLA DRA
33
Q

Compare and contrast Polyarthritis patients that are RF (-) and RF (+)

A

RF (-) patients are: younger onset, less are ANA (+) and have severe arthritis

RF (+) patients are: older onset, more are ANA (+) and have severe arthritis, have rheumatoid nodules, vasculitis, and there is an HLA DRA association

34
Q

Which NSAIDS are FDA approved for pediatric use of JIA?

A
  1. Aspirin
  2. Tolmetin
  3. Naproxen
  4. Ibuprofen
  5. Indomethacin
  6. Meloxicam (Mobic)
  7. Celebrex
35
Q

Which NSAID under low does behaves like a “new kid” but under high doses “old school” and has increased GI effects?

A

Meloxicam

36
Q

How is Methotrexate administered?

A

Sub Q

37
Q

When is improvement seen with Methotrexate?

A

6-8 weeks but can take up to 6 months

38
Q

What labs should you be taking every 6 weeks with a JIA patient who is on Methotrexate?

A
  • CBC

- CMP

39
Q

Which biologic is approved for the treatment of JRA? And how is it administered?

A
  • Enbrel (Etanercept)
  • Sub Q
  • Binds to TNF
40
Q

This drug is used for refractory uveitis, and has a risk of anaphylaxis. How do you administer it? And, what it is?

A
  • Infusion

- Infliximab

41
Q

How does Anakinra (kineret) work?

A

blocks IL-1:

which stimulates synoviocytes and chondrocytes to produce small inflammatory mediators – leading to cartilage destruction and bone erosions

42
Q

When do you use Anakinra?

A

Used in systemic JRA (but not approved)

43
Q

Explain the method of administration of Anakinra

A
  • Daily
  • very painful
  • SQ injections
  • rotation of sites is important
44
Q

How do you treat:

active systemic juvenile idiopathic arthritis in patients 2 years of age and older who have not responded to previous therapy with NSAIDS and steroids?

A

Actemra (Tocilizumab)

45
Q

Explain the method of administration of Actemra (Tocilizumab)

A
  • Given every 2 weeks
  • by IV over one hour

-Dosing interval can be shortened to every week if condition warrants

46
Q

What TNF blocker is approved for children ages 4 to 17?

A

Humira (adalimumab)

47
Q

Explain the method of administration of Humira (adalimumab)

A
  • dose every other week
  • Painful injections, but can add lidocaine to buffer the pain (Hershey study).
  • Can shorten interval to weekly (with auth)
48
Q

What T-lymphocyte modulator is approved for children 6 and older as monotherapy or with methotrexate?

A

Orencia (Abatacept)

49
Q

Explain the method of administration of Orencia (Abatacept)

A

IV over 30 minutes: at 0, 2 4 weeks, then every 4 weeks

50
Q

Explain the method of administration of Orencia (Abatacept) if the patient is over 75 Kg

A
  • follow adult dosing

- Approved for adults: weekly SQ self injection

51
Q

When is it appropriate to administer IV Solumedrol and daily oral Prednisone (Glucocorticosteroids)?

A
  • systemic flares ~ pericarditis or persistent Sx

- temporary measure until DMARD is effective

52
Q

Under what conditions are joint injections usually done?

A

-under sedation

53
Q

What is used at the joint injection and why would someone choose to use it?

A

-Triamcinolone hexacetonide (Aristaspan)

use because:

  • –long acting steroid
  • –Works best with large joints
54
Q

According to the ACR, what is the treatment line for JIA?

A
  • Anakinra
  • Glucocorticoids
  • NSAIDS
55
Q

For JIA patients receiving NSAIDs on a long-term daily basis, what tests should be done and how often should they be done?

A
  • complete blood cell count
  • measurement of liver enzymes
  • serum creatinine
  • urinalysis

–should be done twice yearly

56
Q

For JIA patients taking NSAIDS 3-4 days per week basis, what tests should be done and how often should they be done?

A
  • complete blood cell count
  • measurement of liver enzymes
  • serum creatinine
  • urinalysis

–testing should be repeated annually

57
Q

For JIA patients, what tests should be done?

A
  • complete blood cell count
  • measurement of liver enzymes
  • serum creatinine
58
Q

In JIA patients taking methotrexate, what tests should be done and how often should they be done?

A
  • complete blood cell count
  • measurement of liver enzymes
  • serum creatinine
  • tests should be conducted approximately 1 month after initiation of routine use
  • and approximately 1-2 months after any increase in dose
59
Q

In JIA patients taking methotrexate, what tests should be done and how often should they be done If prior results were normal and the patient is on a stable dose?

A

–the tests can be repeated approximately every 3-4 months

60
Q

In JIA patients taking TNF inhibitors, what tests should be done and how often should they be done?

A

–these tests should be repeated approximately every 3-6 months

–Tuberculosis screening should be repeated approximately once yearly

Clin Med 3-2017 (6 decks)

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