juvenile arthritis Flashcards
rubor common in joint inflammation in JIA
nope, no redness
Arthritis:
- calor (warmth)
- rubor (redness)
- tumor (swelling)
- dolor (pain)
- loss of function (decreased range of motion and stiffness
Arthritis: at least 2 out of 5 signs are present
JIA
- Onset of disease
- Diagnosis of
- Duration of arthritis
- Onset of disease < 16 yrs old (Juvenile)
- Diagnosis of exclusion (Idiopathic)
infections, malignancies, other rheumatic conditions, metabolic/genetic syndromes - Duration of arthritis >6 weeks (Chronic)
physical impact of JIA
joint overgrowth, muscular atrophy, micrognathia, joint flexion and contracture, boney erosions (requires more aggressive treatment)
what type of ankylosis do we see in JIA
loss of cervical lordosis
Leg Length Measurement
From Anterior superior iliac spine (ASIS) to medial malleolus; A difference of greater than 1 to 2 cm is likely functionally significant
JIA classification most common
oligoarticular JIA
Polyarticular JIA (30-35%) RF (+) associated with
seropositive RA
Enthesitis Related Arthritis (5-15%)
Juvenile Ankylosing Spondylitis
associated with
spondyloarthropathy
Juvenile Psoriatic Arthritis (7-8%)
psoriatic arthritis
what is the clinical pearl of oligoarticular JIA
Closely watch the eyes!
Uveitis
< 4 joints in the first 6 months after onset
Often in toddlers (1~2 year-old)
More in girls (F:M = 3:1)
Normal or mildly elevated inflammatory markers
Often has a positive ANA
oligoarticular JIA
> 5 joints in first 6 months of disease Often in teen females Small and large joints; symmetrical Auto-antibodies: RF anti-CCP rarely +ANA
RF+ polyarticular JIA
Similar to RA in adults
>= 5 joint in first 6 months of disease Large and small joints Can be asymmetrical Also watch for uveitis! Similar to oligoarticular JIA except for joint counts Response to treatment/outcomes Risk of uveitis
RF - polyarticular JIA
Fevers for >2 weeks -Quotidian fevers (similar time of the day) Arthritis Typical rash Lymphadenopathy Hepatosplenomegaly Serositis: pleural effusion, pericardial effusion auto-inflammatory
systemic JIA
what types of rash do we see in systemic JIA (not specific)
evanescent rash and koebner phenomenon
SJIA labs
increases levels of C reactive protein, ESR, ferritin, D-dimer, AST, ALT and cell counts such as WBC and PLT
A severe complication, life threatening
7% of sJIA, also reported in other conditions
Excessive activation and expansion of
T lymphocytes
macrophagic histiocytes (hemophagocytic activity)
macrophage activation syndrome (MAS)
difference in clinical labs between SJIA and MAS
MAS has low ESR, WBC and PLT
More often in older boys Arthritis, Enthesitis Risk of ankylosis HLA-B27 associated Acute Anterior Uveitis
ENTHESITIS RELATED ARTHRITIS
enthesitis
inflammation of the tendon
Only half patients have psoriatic rash
Dactylitis (Sausage finger/toe): often in young children
Nail changes (pitting, onycholysis)
Family history of psoriasis in a 1st degree relative
JUVENILE PSORIATIC ARTHRITIS
Iridocyclitis
Inflammation of the anterior uvea (Iris, Ciliary body)
high risk patients for chronic uveitis
- female
- oligoarticular JIA
- RF (-) polyarticular JIA
- Juvenile Psoriatic Arthritis
