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Pediatrics > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

What is JIA?

A
  • Childhood disease→ swelling, inflamm, pain about jts
  • Formerly→ Juvenile Rheumatoid Arthritis (America) and Juvenile Chronic Arthritis (Europe)
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2
Q

JIA Defined:

aka what makes it a JIA dx?

A
  • Arthritis lasting @ least 6wks
  • 1 or more jts
  • Children <16yo
  • WHEN ALL OTHER CAUSES R/O!!!
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3
Q

No neural insult, BUT contractures?

Potential Dx and what to do?

A

Osteoarthritis?

Refer to ortho!!!

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4
Q

JIA Dx:

A
  • NO true Dx test*
  • Mostly clinical and often delayed
  • Non-specific signs:
    • Mild anemia, elevated erythrocyte sedimentation rate (ESR), radiograph evidence jt swelling, osteopenia
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5
Q

JIA Incidence/Prevalence

A

Age of onset/gender vary by type

Girls>Boys

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6
Q

JIA Etiology

Unclear BUT…

A
  • Theory of autoimmune inflammatory disorder:
    • External trigger→ trauma, bact/virus
    • virus/bacterial infx usually precedes onset
    • phys. trauma
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7
Q

Types of JIA:

5:

A
  1. Olioarticular (former→ Pauciarticular)
  2. Polyarticular
  3. Systemic
  4. Enthesitis-related
  5. Psoriatic
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8
Q

Olioarticular JIA

fun fact to KNOW!

A

Usually one-side only

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9
Q

Olioarticular

A
  • 50-60% cases
  • Girls <6yo
  • Sx’s:
    • Mild inflamm in 4 or fewer jt→ KNEE MOST COMMON*
      • ankles, elbows
      • *hip/sm. jts of hands not impacted
    • Joints→ swollen, warm, not too painful
  • EXCELLENT PROGNOSIS*
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10
Q

Olioarticular prognosis

A

EXCELLENT!!!

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11
Q

Polyarticular

*less common

A
  • 25-28%, 5 or more jts
  • Symmetric→ large AND small jts
    • MAY include CS and TMJ*
  • Jts→ swollen, warm, echymosis
  • *Mild systemic sx’s→ low grade fever, hepatosplenomegaly, lymphadenopathy
  • Prognosis→ guarded 2* comps: weakness, contractures
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12
Q

Polyarticular prognosis

A

Guarded (unsure) 2* comps may arise→ weakness, contractures

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13
Q

MOST SERIOUS JIA

A

SYSTEMIC

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14
Q

Dx marker of Systemic JIA

A

High fever

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15
Q

Systemic JIA

A
  • 10-12%, MOST serious
  • Pain in many jts
  • Dx marker==> high fever**
  • Rash→ trunk, limbs, face, palms, soles feet
  • S/S:
    • Pleuritis, pericarditis, myocarditis, hepatosplenomegaly, lymphadenopathy
  • Prognosis→ mod-poor: more severe+more jts
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16
Q

Systemic prognosis

A

Mod-poor bc more severe+many jts

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17
Q

Enthesis-related JIA

A
  • Effects Enthesis→ area where tendons+ligs attach to bone
  • jts also maybe affected
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18
Q

Psoriatic JIA

A
  • Combination→ Jt tenderness + inflammation w/ psoriasis of skin OR probs w/ nails
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19
Q

Cardinal signs of Inflammatory Response:

A
  • Swelling, End range stress pain, 2* swelling and protective mm spasms, Jt stiffness, Chronic inflammation==INCd synovial fluid→
    • All==> DECd phys activity and low bone density + use of corticosteroids==> INCd fx risk
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20
Q

Cardinal signs of Inflammatory Response:

More on Jt Stiffness

A

MOST noted upon waking (AM stiff) OR after prolonged sitting

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21
Q

Cardinal signs of Inflammatory Response:

More on Inflamm==> INCd synovial fluid

A
  • Stretches/weaknes jt capsule + adj. structures
  • Overgrowth, pannus (see pic), spreads/erodes art. cart.==> changes bone surfaces
  • Compromises align, symmetry and stability of jts==> contractures
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22
Q

Medical Mgmt JIA:

Goals→

A
  • Control arthritis, prevent jt erosions, manage extra-articular manifestations
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23
Q

Medical Mgmt JIA:

Coordination w/ drugs

A
  • NSAIDs→ most widely used first line
    • SEs=> GI issues
    • dec fever, pain, inflamm→ DO NOT alter dis. course
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24
Q

Medical Mgmt JIA:

Methotrexate (MTX)

A
  • MOST COMMON used to modify dis. itself***
  • Children w/ systemic and polyarticular
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25
Q

Medical Mgmt JIA:

Last 3 medical mgmt techniques

A

Steroids, Total jt replaces, PT***

26
Q

PT Exam/Physical Manifestations of JIA:

A
  • Jt swell/stiff, pain, limtd mob; soft tissue contractures, AM stiff (better t/o day), mm atrophy/weakness/poor mm endurance, fatigue, decd aerobic cap, osteopenia, gait devs, diff w/ ADLs, act/part restrictions
27
Q

2 Standardized Measures specific to JIA:

A

Articular Severity Score (ASS)

Global Range of Motion Score (GROMS)

ASS and GROMS***

28
Q

Jt Examination: JIA

A
  • Active Jt Motion→ observe child thru series mvmts
  • ***Goniometry recommended!!!
29
Q

Jt Examination: Stick figure method

A
  • Jt counts for swelling and ROM limits
  • Add X’s into circles
30
Q

MM Structure and Function

Mm atrophy and weakness near inflamed joints…

SPECIFICALLY WHERE?

A

PROXIMALLY

31
Q

MM Structure and Function

A
  • MM atrophy and weakness→ proximally
  • may persist AFTER flare up controlled
  • Measure/Monitor→ MM bulk, strength, endurance
32
Q

Strength Testing: JIA

A
  • Functional MM Strength→ observe motor skills and ADLs→ younger children
    • MMT/dynamometry
    • Dynamic strength test once flare-ups controlled***
  • Endurance→ how many reps/timed tasks
33
Q

Aerobic Capacity and Function: JIA

Tests/Assessments to use?

A
  • 6MWT, Peds RPE***
  • LOWER peak workload, peak ex. HR, ex. time vs healthy peers
34
Q

MAJOR cause of act. limits in JIA

A

PAIN

35
Q

Pain and JIA

A
  • MAJOR cause act. limits****, more prev. as child ages
  • Ongoing pain assess:
    • pain hx
    • Pt self-report→ 4yrs and older
  • Behaviors→ guarding, bracing, rubbing, rigidity*
36
Q

Pt self-report pain @ what age?

A

4 yrs +

37
Q

Pain and JIA

Pain Scales:

A

Wong Baker Faces Scale, Oucher, Body Map (color),

Children 7yo and older→ VAS

Varni/Thompson Peds Pain Questionnaire (PPQ)→ parent AND child reports***

38
Q

VAS can be used WHEN for children w/ pain?

A

7yrs and older

39
Q

Varni/Thompson PPQ

What to remember?

A

Parent AND Child reports of pain

40
Q

Growth Disturbance/Postural Abnorms JIA

A
  • Reduction in growth w/ ext’d pds of active disease**
    • systemic steroids exacerbate this
    • Osteoporosis
  • LLDs common→ asymmetrical, premature closure growth plates
  • Observe posture/alignment in sitting AND standing!!!
41
Q

Gait Impairments in JIA

A
  • Decd velocity, Decd cadence, Limtd stride length, Incd APT,
  • Decd hip EXT and PF @ TSt and lack of push-off
  • Maybe→ developed weakness, loss of ROM from scar tissue
  • USE→ gait labs, pedographs, video
42
Q

Role of PT in JIA

Depends on ______ and _______

A

Type; Severity

43
Q

Role of PT depends highly on type and severity of JIA

Oliarticular vs Poly

A
  • Oliarticular→ FEW functional limits, if any
  • Poly→ need assist w/ basic ADLs, moving bw pos’s, stairs, bike, playground w/ peers, etc.
44
Q

Standardized Assessments that examine child’s w/ JIA’s Activity:

2:

A
  1. Childhood Health Assessment Questionnaire:
    1. 1-19yo
    2. 30 activities
    3. parent OR child answers
    4. Has areas to assess length of time for morning stiff and VAS for pain
  2. Juvenile Arthritis Functional Assessment Index (JASI) and Juvenile Arthritis Functional Assessment Report (JAFAR)
    1. Measures physical function**
45
Q

Participation and Activity Limits contd

2 more assessments:

A
  • SFA→ diff @ school
  • Juvenile Arthritis Functional Assessment Scale (JAFAS)
    • observed and timed on 10 tasks
46
Q

Participation/Activity Limits

QoL Measures to use:

A
  • Juvenile Arthritis Quality of Life Questionnaire (JAQQ)
  • Pediatric Quality of Life Questionnaire (PedsQL)
47
Q

PT Interventions:

Goals + guidelines

A
  • Goals→ prevent/min. impairs, maint or improve function, edu/support for pt and fam
  • Phys activity and graded exercise
  • Adherence to HEP CRUCIAL!!!
48
Q

PT Rx for Pain Control

A
  • Anti-inflamms→ may take time
  • Intra-articular steroid injections
  • PRICE:
    • Pain control
    • Rest
    • Ice
    • Compression
    • Elevation
49
Q

PT Rx for Pain Control

Modalities:

A
  • Superficial heat (20 mins), paraffin, biofeedback, imagery/meditation, imagination play
  • *NOTE: US NOT USED FOR THIS POPULATION!!!
50
Q

Education on _________ is super important!!!!

A

Prevention of AM stiffness***

51
Q

EDUCATE! EDUCATE! EDUCATE!

A
  • Regarding prevention of AM stiffness*** (KNOW FOR TEST!!!)
    • Night splints, main. body heat t/o night, pre-bed exercises or parental massage, AM warm bath/mvmt before school
  • sleeping bags, extra layers
52
Q

Managing Joint Impairments

Utilizing ROM program

A
  • “Motion is Lotion”→ Daily ROM program
    • thru FULL ROM 1-2x/day
    • AROM preferable, AAROM if weakness
    • Gental manual stretch when arthritis under control
      • brief 60s, contract release
  • Child moves limb thru full ROM after stretch bc mm in lengthened state
  • Serial casting, spinting/orthoses→ prolonged stretch/pos’ing in more severe/contracted jts
53
Q

Strengthening in JIA

A
  • Target mm’s surrounding effected jts**
  • During acute inflamm:
    • ISOMETRIC only, but caution long holds → may inc intra-articular pressure
  • Dynamic ex’s w/ resolution of inflamm.
  • Bikes, yoga, pilates, aquatics, developmental play, aerobic acts for CV endurance
54
Q

Functional Mobility GOAL for JIA

A

Get children walking again ASAP!!!

55
Q

Functional Mobility and JIA

A
  • Wt bearing/ambulation→ CRUCIAL for bone growth, jt health, mm development
  • Goal→ get children walking again ASAP!!!
    • maybe aides/orthotics initially
    • most do not req. AD but may use AD for long dist’s bc flare-ups
56
Q

Self-Care

Modifications for children:

A
  • Adaptations for grip strength defs
  • Adapted toys/utensils/writing tools
    • replace door knobs/faucets, velcro on shoes, button hooks/zippers
    • Home→ ramps, HRs for tub, raised toilet seat
57
Q

Children w/ JIA undergo Sx procedures for improvement in jt deformity

3 Types Sx:

A
  1. Soft tissue lengthening
  2. Synovectomy
  3. TJA (Total Jt Arthroplasty)
58
Q

Pre-Op PT for JIA:

A

Improve strength, maintain range

59
Q

Post-Op PT for JIA:

A

Return to PLOF!!!

60
Q

School Considerations for JIA Children

A
  • Tardiness due to morning stiffness, Freq. absence 2* systemic issues or f/u appts
  • Incd time for hygiene or getting to class, aide for note taking, untimed tests, mods for gym class
  • All leads to decd social interactions and feelings of isolation***
61
Q

Recreational Activities:

A
  • Stay active and social!
  • Swimming/water or LOW impact aerobics, cycling, yoga→ great acts to promote!
  • *NOTE: AVOID high impact or contact → more inflammatory

Pediatrics (27 decks)

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