Juvenile Idiopathic Arthritis

Question 1

JIA?

Answer 1

Group of systemic inflammatory disorders affecting children <16

Question 2

What can juvenile idiopathic arthritis cause?

Answer 2

Disability and blindess

Question 3

What kind of condition is JIA?

Answer 3

Autoimmune disease

Question 4

What criteria need to be present for a diagnosis of JIA to be made?

Answer 4

<16
>4 weeks
Presence of arthritis- joint swelling and 2 of the following; painful/limited joint motion, tenderness, warmth

Question 5

Which imaging can be used to confirm JIA?

Answer 5

MRI or ultrasound

Question 6

After six months, patients with JIA divide into three major subtypes.
What are these three subtypes?

Answer 6

Oligoarticular
Polyarticular
Systemic onset

Question 7

Oligoarticular?

Answer 7

4 or fewer joints involved

Question 8

Polyarticular?

Answer 8

> 5 joints involved

Question 9

Most common subtype of JIA?

Answer 9

Oliogoartciular

Question 10

Who is more likely to develop oligoartciular JIA?

Answer 10

Girls > boys
Usually before 5yrs, peak 1-3

Question 11

How does oligoarticular JIA tend to present in the younger child?

Answer 11

Limp- may not be too painful as it is a gradual, progressive condition

Question 12

If you see a pre-school girl with a limp, what else do you need to check?

Answer 12

Eyes

->may be another condition which leads to blindness

Question 13

Which joints tend to be more commonly affected in oligoarticular JIA?

Answer 13

Mainly LL joints

Question 14

A lot of patients with oligoarticular JIA are positive for which antibody?

Answer 14

ANA- antinuclear antibody

->test for autoimmune disease

Question 15

What does a positive ANA tell you a child is at high risk of alongside their arthritis?

Answer 15

Eye disease

->this associated eye disease is asymptomatic in 50%

Question 16

Uveitis?

Answer 16

Inflammation of the uvea/iris of eye

Question 17

If a patient with type 2 oligoarticular JIA has hip involvement, what antigen is tested for?

Answer 17

HLA-B27, if present, diagnosed with Juvenile spondyloarthritis

Question 18

What is a sign in presentation of type 3 oligoartciluar JIA?

->note that the lecturer said not to worry too much about type 1, 2, 3 oligoarthritis JIA in detail, more just oligoarticular JIA as a whole

Answer 18

Asymmetric UL and LL arthritis
Dactylitis- sausage fingers/toes, swelling

Question 19

In type 3 oligoarthritic JIA, family history of what occurs in approx 40?

Answer 19

FH of psoriasis

Question 20

Second most common type of JIA?

Answer 20

Polyarticular JIA

Question 21

Age and sex most likely to develop polyarticular JIA if there is a negative RF (rheumatoid factor)?

->note that most are RF negative

Answer 21

Ang age, often early
Girls > boys

Question 22

Presentation of polyarticular JIA with negative RF?

Answer 22

Constitutional manifestations e.g. low grade fever, malaise
Hepato-splenomegaly
Mild anaemia
Growth abnormalities

Question 23

Age and sex most likely to develop polyarticular JIA if there is a positive RF (rheumatoid factor)?

->note that most are RF negative

Answer 23

Late childhood, 12-16yrs
Girls>boys

Question 24

Presentation of polyarticular JIA with positive RF?

Answer 24

Constitutional manifestations e.g. low grade fever, malaise, weight loss
Anaemia
Rheumatoid nodules

Question 25

Is uveitis more common in oligoarticular JIA or polyarticular JIA?

Answer 25

Oligoarticular JIA

Question 26

What subtype of JIA is the most serious in terms of long AND short term morbidity?

Answer 26

Systemic onset of JIA

->systemic symptoms can delay diagnosis

Question 27

Features of systemic onset JIA?

Answer 27

Fever
Rash- trunk and thighs
Abdominal pain
Hepatosplenomegaly
Lung fibrosis
Arthritis

->no one knows where fever is coming from, gradually more confusing features develop, until the arthritis develops after about a year from the onset of symptoms

Question 28

Diagnosis of JIA?

Answer 28

History and examination based
Some bloods

Question 29

If doing bloods if suspecting JIA, what would you expect to see?

Answer 29

Elevated ESR

->very high in systemic JIA which can be confusing when unsure of diagnosis as does not correlate with disease activity

Question 30

Rheumatoid factor is positive in what % of polyarticular JIA patients?

Answer 30

15-20%

Question 31

ANA is positive in what % of oligoarticular JIA patients?

Answer 31

60%

->seen in 75% of any JIA

Question 32

RECAP- investigation to confirm joint inflammation?

Answer 32

MRI
Ultrasound

Question 33

First line therapy for JIA?

Answer 33

Simple analgesics
NSAIDs

Question 34

Second line therapy for oligoarticular JIA?

Answer 34

Can respond well to NSAIDs/joint injections

Methotrexate
Anti-TNF therapies if methotrexate fails

Question 35

Systemic steroids have limited use due to serious side effects. When would they be used in JIA?

Answer 35

Systemic JIA to control pain and fever

Question 36

What are some of the risks of systemic steroids?

Answer 36

Osteoporosis, infections, growth abnormalities

Question 37

Treatment for the uveitis in patients with oligoarticular JIA?

Answer 37

Topical steroids

Question 38

What are other features of management in a child with JIA?

Answer 38

Family support
School support
Rehabilitation; physio and OT

Question 39

What is the role of surgery in JIA?

Answer 39

Reconstructive/ joint replacement therapy if out of control