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Musculoskeletal > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

What is juvenile idiopathic arthritis?

A

Is a group of systemic inflammatory disorders affecting children < 16 years

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2
Q

What is the aetiology of JIA?

A

Aetiology:

  • Autoimmune disease with multifactorial pathogenesis
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3
Q

What does JIA stand for?

A

Juvenile idiopathic arthritis

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4
Q

What is the prevalence of JIA?

A

1/1000 children <16 years

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5
Q

What is the critieria for diagnosis of JIA?

A
  • Age of onset
    • <16 years
  • Duration of disease
    • >6 weeks
  • Presence of arthritis
    • Joint swelling or 2 of the following
      • Painful or limited joint motion
      • Tenderness
      • Warmth
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6
Q

What are the different clinical subtypes of JIA?

A

Pauciarticular (most prevalent)

Polyarticular

Systemic onset

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7
Q

What is the most common clinical subtype of JIA?

A

Pauciarticular

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8
Q

How many joints does pauciarticular JIA affect?

A

4 or less

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9
Q

What are the different types of pauciarticular JIA?

A
  • Type 1
    • Most prevalent type
    • Age < 5 years
    • Girls:boys 8:1
    • Presentation is limp rather than pain and stiffness, chronic uveitis, irregular iris
    • Knee > ankle > hand or elbow
  • Type 2
    • Age after 8-9
    • Girls:boys 1:7
    • Presentation – lower limp joint affected (hip can be affected), acute iridocyclitis
  • Type 3
    • Any age
    • Girls:boys 4:1
    • Presentation – constitutional rare, asymmetric upper limb or lower limb, dactylitis, chronic iridocyclitis
    • Can be associated with psoriasis (family history)
  • Extended oligoarthritis
    • Present in pauciarticular way (<4 joints) but then go onto develop polyarticular arthritis
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10
Q

What is the most prevalent type of pauciarticular JIA?

A

Type 1 pauciarticular JIA

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11
Q

Describe the epidemiology of type 1 pauciarticular JIA in terms of sex and age?

A
  • Age < 5 years
  • Girls:boys 8:1
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12
Q

Describe the epidemiology of type 2 pauciarticular JIA in terms of sex and age?

A
  • Age after 8-9
  • Girls:boys 1:7
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13
Q

Describe the epidemiology of type 3 pauciarticular JIA in terms of sex and age?

A
  • Any age
  • Girls:boys 4:1
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14
Q

What is the presentation of type 1 pauciarticular JIA?

A
  • Presentation is limp rather than pain and stiffness, chronic uveitis, irregular iris
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15
Q

What is the presentation of type 2 pauciarticular JIA?

A
  • Presentation – lower limp joint affected (hip can be affected), acute iridocyclitis
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16
Q

What is the presentation of type 3 pauciarticular JIA?

A
  • Presentation – constitutional rare, asymmetric upper limb or lower limb, dactylitis, chronic iridocyclitis
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17
Q

What type of pauiarticular JIA can be associated with psoriasis?

18
Q

Where does type 1 pauciarticular JIA most commonly affect?

A
  • Knee > ankle > hand or elbow
19
Q

What is extended oligoarthritis?

A
  • Present in pauciarticular way (<4 joints) but then go onto develop polyarticular arthritis
20
Q

How many joints does polyarticular JIA affect?

21
Q

What are the clinical subtypes of polyarticular JIA?

A
  • Divided into rheumatoid factor + and –
22
Q

Describe the epidemiology of polyarticular -ve JIA in terms of sex and age?

A
  • Any age
  • Girls:boys 9:1
23
Q

Describe the epidemiology of polyarticular +ve JIA in terms of sex and age?

A
  • Late childhood
  • Girls:boys 7:1
24
Q

What is the presentation of polyarticular -ve JIA?

A
  • Presentation – constitutional manifestations (fever, malaise), hepato-splenomegaly, anaemia, restriced growth, symmetric arthritis on large and small joints (knees, wrists, ankles, MCPs, PIPs, neck), uveitis rare
25
What is the presentation of polyarticular +ve JIA?
* Presentation – constitutional manifestations, anaemia, nodules, erosions in x-ray, uveitis rare
26
What is systemic onset JIA known as?
STILL's disease
27
Describe the epidemiology of systemic onset JIA in terms of sex and age?
* Any age * Girls:boys 1.5:1
28
What is the characteristic presentation of systemic onset JIA?
* Characteristic presentation is fever that rises daily then returns back to normal after 2 weeks with no other obvious cause, rash described as salmon red eruption on trunk and thighs, lymphadenopathy, hepatosplenomegaly with abdominal pain, serositis, lung involvement rare
29
Is the arthritis in systemic onset JIA usually pauciarticular or polyarticular?
Polyarthritis
30
What is uveitis?
Inflammation of the middle layer of eyeball, which consists of iris, ciliary, body and choroid
31
In what clinical subtype of JIA is uveitis most common?
32
What should every child with arthritis be screened for?
Eye problems (uveitis)
33
What are potential complications of uveitis?
Is a cause of potential blindness, other complications includes: * Posterior synechiae * Cataracts * Band keratopathy
34
What is the treatment of uveitis?
* Steroids * First topical, sometimes systemic required * Mydriatic and cycloplegic agents * Methotrexate * MMF * Ciclosporin * Anti-TNF
35
Describe the management of JIA?
* First line therapy * Simple pain killers * NSAIDs * Second line therapy * If no response to NSAIDs/joint steroid injection * 1) Methotrexate * 2) Anti-TNF * 3) IL-1 R-antagonist in refractory systemic arthritis * 4) IL-6 antagonist for refractory systemic disease * Rehabilitation * Physiotherapy * Occupational therapy * Surgical treatment * Synovectomy * Reconstructive/joint replacement surgery
36
What is the first line therapy for JIA?
* First line therapy * Simple pain killers * NSAIDs
37
What is the second line therapy for JIA?
* Second line therapy * If no response to NSAIDs/joint steroid injection * 1) Methotrexate * 2) Anti-TNF * 3) IL-1 R-antagonist in refractory systemic arthritis * 4) IL-6 antagonist for refractory systemic disease
38
Why do systemic steroids have limited indications in JIA?
Due to serious side effects
39
What are indications for systemic steroids in JIA?
* Systemic JIA to control pain and fever * Serious disease complications with any subtype * As a bridge between DMARDs
40
What kinds of growth failure can occur in JIA?
* Localised growth failure * Leg length discrepancies * Shortening of fingers, hands, forearms, toes, feet * Micrognathia (poor growth of mandible) * Implications for tooth development and appearance * Generalised growth failure * Related to severe systemic disease * Short stature * Delayed puberty
41
What is micrognathia?
* Micrognathia (poor growth of mandible) * Implications for tooth development and appearance

Musculoskeletal (41 decks)

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