Juvenile Arthritis - Told Flashcards
juvenile arthritis
called juvenile idiopathic arthritis
pauci
<5 joints
5 or 6 joints
extended pauci
poly
> 6 joints
2-4 joints
olig
JIA demographics
onset usually <9yo
diagnosis of JIA
age 6months
arthritis 1 or more joints
subtypes of JIA
systemic onset
pauciarticular - 1, 2, 3
polyarticular - RF + or -
morning stiffness
think RA
pauciarticular type 1
classic
pauciarticular type 2
spondylitic - only back
enthesis related
pauciarticular type 3
psoriatic - nail and skin exam necessary
RF negative
growing pain
age 6-13 years thigh, calf, shin localized - not joints pain at night correlated with strenuous exertion tx - heat, massage, analgesics
stills disease
systemic JIA
malaise, fever**, rash,a denopathy, hepatosplenomegaly, serositis, hepatitis, DIC, anemia
5yo F > M
fever in systemic JRA
waxes and wanes
JRA rash
salmon pink
circumscribed pink
2-6mm or greater
chest, axilla, upper arms
often itchy
labs of systemic JIA
high ESR
anemia, leukocytosis (polys), thrombocytosis
RF negative**
younger age of systemic JIA
worse prognosis
amyloidosis
with persistent systemic JIA
most common pauciarticular disease
subtype 1
age M
clinical of type I pauciarticular
<5 joints - knee, ankle, elbow, hip
early growth abnormalities
chronic uveitis** within 5 years
labs of type I pauciarticular
ESR increased or wnl CBC normal RF negative ANA positive** HLA A2, DR5, DRw6 and Drw8
iridocyclitis
develops in 2/3 of type I pauciarticular disease
need opthalmolgic consult
juvenile spondyloarthropathy
pauciarticular type II
pauciarticular type II clinical
age >9yo
M>F
peripheral arthritis
enthesopathies
acute arthritis
labs of pauciarticular type II
ESR normal or high
CBC normal
RF negative
HLA-B27 positive**
psoriatic
pauciarticular type III
pauciarticular type III clinical
F>M
8yo
fam hx of psoriasis
rarely systemic
dactylitis - swollen digits psoriatic rash - extensor surfaces nail pits onchylosis flexor tenosynovitis
remitting and relapsing - even into adulthood
pauciarticular type III labs
ESR varies
CBC variable
RF negative
polyarticular JRA
> 5 joints
RF positive - more severe disease
RF negative polyarticular
M
any joint reduced neck and TMJ ROM flexor tenosynovitis low grade fever possible mild lymphadenopathy/hepatosplenomegaly
labs with RF negative polyarticular
ESR increase
CBC - anemia, leukocytosis, thrombocytopenia
RF negative
RF positive polyarticular
> 8yo and F>M
polyarthritis of any joints
rheumatic nodules**
vasculitis - uncommon and late
cervical subluxation
RF positive polyarticular
RF positive polyarticular labs
ESR increased CBC moderate anemia RF positive** ANA may be positive HLA-DR4 - frequently positive
X-ray erosive changes
tx of RF positive polyarticular
NSAIDs
gold
sulfasalfazine
etanercept
prognosis of polyarticular RF positive
serious joint destruction and poor function
cervical subluxation
aortic insufficiency and amyloidosis
