Juvenile Idiopathic Arthritis Flashcards
What is Juvenile idiopathic arthritis?
Arthritis occurring in:
• Someone who is less than 16 years old
• Lasts for more than 6 weeks.
How long does the arthritis need to last to be classed as JIA?
Moe than 6 weeks
Who does JIA affect?
People below the age of 16
What are the key features of inflammatory arthritis?
- Joint pain
- Swelling
- Stiffness.
What are the 5 main subtypes of JIA?
- Systemic JIA
- Polyarticular JIA
- Oligoarticular JIA
- Enthesitis related arthritis
- Juvenile psoriatic arthritis
What is another name for systemic JIA?
Stills disease
What is the characteristic feature of stills disease
Salmon-pink rash
What are the other features of systemic arthritis?
- pyrexia
- lymphadenopathy
- uveitis
- anorexia and weight loss
What will be negative in someone with systemic JIA?
Antinuclear antibodies (ANA) and rheumatoid factors
What will be raised in someone with systemic JIA?
Inflammatory markers, with raised CRP, ESR, platelets and serum ferritin
What is the main complication of systemic JIA?
Macrophage activation syndrome (MAS)
How does macrophage activation syndrome present?
- An acutely unwell child
- Disseminated intravascular coagulation (DIC)
- Anaemia
- Thrombocytopenia
- Bleeding
- Non-blanching rash
What is a key features of macrophage activation syndrome?
A key investigation finding is a low ESR.
What skin feature is present with macrophage activation syndrome?
Non-blanching rash
What is Polyarticular JIA?
Idiopathic inflammatory arthritis in 5 joints or more.
How does polyarticular JIA present?
Symmetrical
Which joints does polyarticular JIA tend to affect?
Small joints of the hands and feet, as well as the large joints such as the hips and knees.
What systemic features can present with polyarticular JIA?
- Mild fever
- Anaemia
- Reduced growth
Are systemic symptoms common with polyarticular JIA?
No
What is the equivalent of polyarticular JIA in adults?
Rheumatoid arthritis
What is negative with polyarticular arthritis?
Rheumatoid factor-seronegative
What is another name for Oligoarticular JIA?
Pauciarticular JIA
How many joints does Oligoarticular JIA affect?
4 joints or less.
How many cases of JIA does oligoarticular arthritis make up?
60% of cases of JIA
Which joints does oligoarticular arthritis affect?
Larger joints- Knee or ankle
Who does oligoarticular arthritis typically affect?
Girls under the age of 6 years.
How many joints does oligoarticular arthritis typically affect?
One- monoarthritic
What is oligoarticular arthritis associated with?
Anterior uveitis
Do patients with oligoarticular arthritis typically have systemic symptoms?
No
What is usually positive in someone with oligoarticular arthritis?
ANA antibodies
What is usually negative in someone with oligoarticular arthritis?
Rheumatoid factor
In who is enthesitis-related arthritis more common?
More common in male children over 6 years.
What is enthesitis-related arthritis a paediatric version of?
Seronegative spondyloarthropathy group of conditions that affect adults.
What is enthesitis?
Inflammation of the insertion point of the tendon onto the bone
What do the majority of patient with enthesitis-related arthritis have?
HLA-B27 gene
What are potential signs and symptoms of enthesitis-related arthrtis?
Signs and symptoms of psoriasis- psoriatic plaques and nail pitting
Inflammatory bowel disease- intermitted diarrhoea and rectal bleeding
What are patients with enthesitis-related arthritis prone to?
Anterior uveitis
What is the treatment progression for JIA?
- NSAIDs, such as ibuprofen
- Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
- Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine and leflunomide
- Biologic therapy, such as the tumour necrosis factor inhibitors etanercept, infliximab and adalimumab
Which NSAID could you give for JIA?
Ibuprofen
Which DMARD’s could you give for JIA?
Methotrexate
Sulfasalazine
Leflunomide
Which biological therapies could you give for JIA?
Tumour necrosis factor inhibitors:
Etanercept
Infliximab
Adalimumab
Which biological therapies could you give for JIA?
Tumour necrosis factor inhibitors:
Etanercept
Infliximab
Adalimumab
