juvenile idiopathic arthritis

Question 1

JIA

Answer 1

condition affecting children and adolescents where autoimmune inflammation occurs in the joints.
arthritis without any other cause (pain, limited range of motion, tenderness, warmth), lasting more than 6 weeks in a patient under the age of 16

Question 2

features of JIA

Answer 2

joint pain, swelling and stiffness.

Question 3

types of JIA

Answer 3

Systemic JIA
Polyarticular JIA
Pauciarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis

some people prefer enjoying joints

Question 4

systemic JIA aka stills disease

Answer 4

Subtle salmon-pink rash. trunk and thighs
High swinging fevers, rise to 39.5 daily for 2 weeks
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
bendy and hyperflexible
Pleuritis and pericarditis

Question 5

investigations systemic JIA

Answer 5

Antinuclear antibodies and rheumatoid factors typically negative.
raised inflammatory markers, with raised CRP, ESR, platelets and serum ferritin.

Question 6

polyarticular jia

Answer 6

idiopathic inflammatory arthritis in 5 joints or more
2nd most common
symmetrical
Systemic symptoms are mild
equivalent of rheumatoid arthritis in adults
seronegative usually but can be RF positive

Question 7

Oligoarticular JIA- pauciarticular

Answer 7

4 joints or less. Usually it only affects a single joint
most common
tends to affect the larger joints

3 types

Question 8

enthesitis related arthritis

Answer 8

more common in male children over 6 years
paediatric version of the seronegative spondyloarthropathy
MRI scan of the affected joint can demonstrate enthesitis, but cannot distinguish between an enthesitis due to stress or an autoimmune process.
HLA B27 gene positive
consider signs and symptoms of psoriasis and inflammatory bowel disease
anterior uveitis
tender to localised palpation of the entheses

Question 9

juvenile psoriatric arthritis

Answer 9

psoriasis
joint involvement pattern varies
nail pitting
oncholysis- separation of the nail from the nail bed
dactylitis
enthesitis

Question 10

management of JIA

Answer 10

1st NSAIDs or steroid injections
2nd methotrexate
anti TNF
IL1R antagonist
IL6 antagonist

systemic steroids in systemic JIA, serious complications, bridge between DMARDs, if undergoing surgery

physio and OT
avoid surgery as much as possible

Question 11

pauciarticular type1

Answer 11

limp rather than pain
no constitutional manifestations
mainly lower limb
hip very rare
knee most common
positive ANA in 40-75%
50% asymptomatic
uveitis

Question 12

pauciarticualr arthritis type 2

Answer 12

boys more than girls
limp, mainly lower limb
rare systemic
hip can be affected early with rapid damage
require THR early in life and may progress into spondyloarthritis

HLA B27 and back involvement - ankylosing spondylitis

Question 13

pauciarticular arthritis type 3

Answer 13

systemic rare
asymmetric UL and LL arthritis
dactylitis
psoriasis in 40%
can be destructive
needs eye screening

Question 14

polyarticular RF negative

Answer 14

girls much more common any age
low grade fever, malaise
mild anaemia
growth abnormalities
hepato-splenomegaly
symmetrical
uveitis rare

Question 15

polyarticular RF positive

Answer 15

girls age 12-17
similar to adult RA
erosions in xray occur early
uveitis rare

Question 16

what screening is required in JIA

Answer 16

eye. uveitis. treat with steroids

Question 17

types of growth failure

Answer 17

very important aspect

leg length discrepencies
shortening of fingers, forearms, toes
micrognathia- mandible
short stature
delayed puberty