Juvenile Idiopathic Arthritis

Question 1

What is Juvenile idiopathic arthritis?

Answer 1

Arthritis occurring in:
• Someone who is less than 16 years old
• Lasts for more than 6 weeks.

Question 2

How long does the arthritis need to last to be classed as JIA?

Answer 2

Moe than 6 weeks

Question 3

Who does JIA affect?

Answer 3

People below the age of 16

Question 4

What are the key features of inflammatory arthritis?

Answer 4

• Joint pain
• Swelling
• Stiffness.

Question 5

What are the 5 main subtypes of JIA?

Answer 5

• Systemic JIA
• Polyarticular JIA
• Oligoarticular JIA
• Enthesitis related arthritis
• Juvenile psoriatic arthritis

Question 6

What is another name for systemic JIA?

Answer 6

Stills disease

Question 7

What is the characteristic feature of stills disease

Answer 7

Salmon-pink rash

Question 8

What are the other features of systemic arthritis?

Answer 8

• pyrexia
• lymphadenopathy
• uveitis
• anorexia and weight loss

Question 9

What will be negative in someone with systemic JIA?

Answer 9

Antinuclear antibodies (ANA) and rheumatoid factors

Question 10

What will be raised in someone with systemic JIA?

Answer 10

Inflammatory markers, with raised CRP, ESR, platelets and serum ferritin

Question 11

What is the main complication of systemic JIA?

Answer 11

Macrophage activation syndrome (MAS)

Question 12

How does macrophage activation syndrome present?

Answer 12

• An acutely unwell child
• Disseminated intravascular coagulation (DIC)
• Anaemia
• Thrombocytopenia
• Bleeding
• Non-blanching rash

Question 13

What is a key features of macrophage activation syndrome?

Answer 13

A key investigation finding is a low ESR.

Question 14

What skin feature is present with macrophage activation syndrome?

Answer 14

Non-blanching rash

Question 15

What is Polyarticular JIA?

Answer 15

Idiopathic inflammatory arthritis in 5 joints or more.

Question 16

How does polyarticular JIA present?

Answer 16

Symmetrical

Question 17

Which joints does polyarticular JIA tend to affect?

Answer 17

Small joints of the hands and feet, as well as the large joints such as the hips and knees.

Question 18

What systemic features can present with polyarticular JIA?

Answer 18

• Mild fever
• Anaemia
• Reduced growth

Question 19

Are systemic symptoms common with polyarticular JIA?

Answer 19

No

Question 20

What is the equivalent of polyarticular JIA in adults?

Answer 20

Rheumatoid arthritis

Question 21

What is negative with polyarticular arthritis?

Answer 21

Rheumatoid factor-seronegative

Question 22

What is another name for Oligoarticular JIA?

Answer 22

Pauciarticular JIA

Question 23

How many joints does Oligoarticular JIA affect?

Answer 23

4 joints or less.

Question 24

How many cases of JIA does oligoarticular arthritis make up?

Answer 24

60% of cases of JIA

Question 25

Which joints does oligoarticular arthritis affect?

Answer 25

Larger joints- Knee or ankle

Question 26

Who does oligoarticular arthritis typically affect?

Answer 26

Girls under the age of 6 years.

Question 27

How many joints does oligoarticular arthritis typically affect?

Answer 27

One- monoarthritic

Question 28

What is oligoarticular arthritis associated with?

Answer 28

Anterior uveitis

Question 29

Do patients with oligoarticular arthritis typically have systemic symptoms?

Answer 29

No

Question 30

What is usually positive in someone with oligoarticular arthritis?

Answer 30

ANA antibodies

Question 31

What is usually negative in someone with oligoarticular arthritis?

Answer 31

Rheumatoid factor

Question 32

In who is enthesitis-related arthritis more common?

Answer 32

More common in male children over 6 years.

Question 33

What is enthesitis-related arthritis a paediatric version of?

Answer 33

Seronegative spondyloarthropathy group of conditions that affect adults.

Question 34

What is enthesitis?

Answer 34

Inflammation of the insertion point of the tendon onto the bone

Question 35

What do the majority of patient with enthesitis-related arthritis have?

Answer 35

HLA-B27 gene

Question 36

What are potential signs and symptoms of enthesitis-related arthrtis?

Answer 36

Signs and symptoms of psoriasis- psoriatic plaques and nail pitting Inflammatory bowel disease- intermitted diarrhoea and rectal bleeding

Question 37

What are patients with enthesitis-related arthritis prone to?

Answer 37

Anterior uveitis

Question 38

What is the treatment progression for JIA?

Answer 38

* 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

Question 39

Which NSAID could you give for JIA?

Answer 39

Ibuprofen

Question 40

Which DMARD's could you give for JIA?

Answer 40

Methotrexate Sulfasalazine Leflunomide

Question 41

Which biological therapies could you give for JIA?

Answer 41

Tumour necrosis factor inhibitors: Etanercept Infliximab Adalimumab

Question 42

Which biological therapies could you give for JIA?

Answer 42

Tumour necrosis factor inhibitors: Etanercept Infliximab Adalimumab