Juvenile Idiopathic Arthritis Flashcards
What is juvenile Idiopathic Arthritis?
- arthritis beginning before age 16
- most common arthritis seen in children
- autoimmune
etiology
- probs multifactorial
- possibly: infection, autoimmune, trauma, stress, genetics
- Common theory: genetic predisposition activated by infection or trauma –> immunologic response –> inflammation
- often see following high fever
differential diagnosis
- < 16 yo
- joint pain in >1 joint for > 6 weeks or 2 weeks of decreased ROM, tenderness or pain with joint movement, and fever
- rule out other causes
other manifestations
- Uveitis: iris of eye
- Pleuritis: lungs
- Pericarditis: heart
Lab Test Results
- Negative for Rheumatoid Factor
- If +RF, likely polyarticular JIA, and worst prognosis
- ANA, HLA-B27, ESR or sed rate, C-reactive protein
initial signs/symptoms
Swelling, inflammation, warmth, fever, rash, guarding/limping, pain,
stiffness, decreased ROM, decreased physical activity, fatigue, difficulty sleeping, swollen lymph nodes, decreased appetite and/or weight loss, thickened synovium
Polyarticular soft tissue changes
Synovial hypertrophy
Marked lymph nodes
Mm/tendon inflammation
Capsular hypertrophy
Ligamentous laxity
Body changes
Irregular bone growth
Osteoporosis
Joint space narrowing
Angular deformity
Limb length discrepancy
Musculoskeletal impairments
Pain
Stiffness (primarily morning)
Weakness
Contractures
Substitution patterns
Postural deformities
Flexion, varus, valgus deformities
Low bone mineral density
Cardiopulmonary Impact
Impaired aerobic fitness and anaerobic capacity
Due to decreased activity level, muscle atrophy, and weakness
Greatest in children with +RF
Cardiac involvement can include pericarditis, pericardial effusion, myocarditis, valvular disease
Types of JIA
- Polyarticular
- Pauciarticular
- Systemic
Polyarticular JIA
> 5 joints affected
Onset 1-3 years or in puberty Joints frequently involved - knees, ankles, wrists, cervical spine, TMJ; often symmetrical
involvement
Prognosis: 40%-50% of patients have active disease 10 years post diagnosis
Affects females more often than males
Pauciarticular JIA (oligoarthritis)
1-4 joints affected
Onset < 7 yrs of age (differs from your text – use this guideline)
Frequently involves knees, ankles, wrists
Prognosis: 20%-70% of patients have symptoms 10 years post diagnosis (Severe arthritis is rare)
- 20% of patients have inflammation of iris
Affects females more often than males.
Systemic JIA
- often proceeded by high fever (>103) and rash
- enlargement of liver, spleen, lymph nodes
- prognosis: 25-60% have symptoms past 10 yrs diagnosis
- females and males affected equally
Which type of JIA is most likely to cause development of severe arthritis
polyarticular with +RF
Most common type of JIA
Pauciarticular
Medications
-NSAIDs
- DMARDs
- Biologic Response Modifiers
- Corticosteroids
- Immunosuppressant, cytocix agent
Side effects of DMARDs
kidney problems, rash, anemia
Biologic Response modifiers
suppress immune system
increased risk of infection
immunosuppressant and cytoxic agent side effects
liver damage
bone marrow suppression
surgical options: synovesctomy
remove inflamed synovium
surgical options: soft tissue release
decrease contracture and increase ROM
surgical options: osteotomy
improve skeletal alignment
surgical options: epiphysiodesis
fuse the growth plate to correct LLD and angular deformity
issues with surgical intervention
long periods of immobilization are contraindicated
objectives of rehabilitation
Maximize functional capacity Control pain/stiffness
Prevent ROM limitations
Maintain and improve mm strength
Increase and maintain endurance/fitness (when disease under control/remission)
Minimize effects of inflammation
Ensure normal growth and development
musculoskeletal inflammation has negative impact on…
growth and development of musculoskeletal system
what occurs when children naturally assume position of comfort?
- painful joints tighten
- they go into flexed position
- weakness of extensors
history
- family history
- medications
- onset
- history of fever/illness/rash before onset
Systems review
- sensory (vision)
- cardiovascular and pulmonary
- MSK
- integument: rash, swelling, warmth, redness
Objective Tests and Measures
- aerobic capacity
- anthropometrics
- gait, locomotion, balance
- muscle performance
- pain
- posture
- ROM
- self- care
-work, community, leisure
anthropometric measurements
- limb length
- joint count stick figure (swelling)
Gait, locomotion, balance
Velocity, cadence, step length may be decreased compared to peers
Often see anterior pelvic tilt, decreased hip and knee extension
Individual variations due to ROM limitations, limb length differences, foot position
I skipped outcome measures
it aint on objectives
intervention strategies are dependent upon:
- site of service delivery: acute, home health, school system, JIA clinic
- Age
- current disease state (acute flare vs chronic)
Physical agents for symptom management
Acute Flare (Pain): Medication adjustment, ice and rest
Chronic (Stiffness): Hydrotherapy, aquatics, paraffin, ultrasound not recommended
Manual Therapy Techniques
Soft tissue techniques for pain relief, stress reduction, and warm-up
Therapeutic exercise: flexibility
Acute Flare: Positioning/joint protection (spine extension), AROM/AAROM (no
PROM), support joints/limbs (splints, orthotics)
No stretching/PROM when in a flare up!
Chronic: Gentle PROM, positioning/joint protection, start with warm-up
Aerobic capacity/ endurance training
Recommend low impact weight bearing activities
Moderate intensity
No more than 30 minutes/day
Children with severe hip disease may have increased pain/symptoms
strength training
Joint protection and disuse atrophy
Acute flare: isometric exercise
Chronic: active, active assisted, resisted exercises
functional training
- ADL/IADL
- Use of AD/orthotics/ adaptive equipment
education
Coordination of care between team members
IEP/504 Plan for assistance and accommodations at school as needed
Patient/Caregiver Education
