Juvenile Idiopathic Arthritis

Question 1

What is juvenile idiopathic arthritis?

Answer 1

Autoimmune disease, immune system targets synovial membrane lining the joint.

Question 2

At what age does juvenile idiopathic arthritis occur and how long does it last?

Answer 2

1. Before 16 years old

2. >3 months long

Question 3

What are the three types of juvenile idiopathic arthritis?

Answer 3

1. Still’s disease - systemic onset
2. Oligoarthritis - most common (4 joints)
3. Polyarthritis - 2nd most common (>4 joints)

Question 4

What are the clinical features of Still’s disease?

Answer 4

1. <5 years old
2. Symmetrical - knees, hands, and feet
3. Joint involvement preceded by swinging fever, tiredness, salmon pink macular rash, enlarged axillary glands, hepatosplenomegaly, pericarditis.

Question 5

What are the clinical features of juvenile idiopathic oligoarthritis?

Answer 5

Asymmetrical - knee, ankle and elbow most commonly affected - up to 4 joints.

Question 6

What are the clinical features of juvenile idiopathic polyarthritis?

Answer 6

1. > 8 years old
2. Symmetrical affecting large and small joints (>4)
3. Later involvement with TMJ and cervical spine

Question 7

How is juvenile idiopathic arthritis diagnosed?

Answer 7

1. Clinical, exclude other causes of polyarthritis.
2. Exclude septic arthritis and malignancy
3. FBC, x-ray, blood film, CRP, ESR

Question 8

What is the management of juvenile idiopathic arthritis?

Answer 8

1. Regular weight bearing exercise, physiotherapy
2. DMARDs (methotrexate)
3. Short term prednisolone
4. NSAIDs
5. Regular slit lamp eye examination to monitor anterior uveitis

Question 9

What is the prognosis of juvenile idiopathic arthritis?

Answer 9

1. Many go into remission
2. 30% will continue to have active disease
3. Joint damage may require replacement surgery in early adulthood