Juvenile Idiopathic Arthritis Flashcards
JIA?
Group of systemic inflammatory disorders affecting children <16
What can juvenile idiopathic arthritis cause?
Disability and blindess
What kind of condition is JIA?
Autoimmune disease
What criteria need to be present for a diagnosis of JIA to be made?
<16
>4 weeks
Presence of arthritis- joint swelling and 2 of the following; painful/limited joint motion, tenderness, warmth
Which imaging can be used to confirm JIA?
MRI or ultrasound
After six months, patients with JIA divide into three major subtypes.
What are these three subtypes?
Oligoarticular
Polyarticular
Systemic onset
Oligoarticular?
4 or fewer joints involved
Polyarticular?
> 5 joints involved
Most common subtype of JIA?
Oliogoartciular
Who is more likely to develop oligoartciular JIA?
Girls > boys
Usually before 5yrs, peak 1-3
How does oligoarticular JIA tend to present in the younger child?
Limp- may not be too painful as it is a gradual, progressive condition
If you see a pre-school girl with a limp, what else do you need to check?
Eyes
->may be another condition which leads to blindness
Which joints tend to be more commonly affected in oligoarticular JIA?
Mainly LL joints
A lot of patients with oligoarticular JIA are positive for which antibody?
ANA- antinuclear antibody
->test for autoimmune disease
What does a positive ANA tell you a child is at high risk of alongside their arthritis?
Eye disease
->this associated eye disease is asymptomatic in 50%
Uveitis?
Inflammation of the uvea/iris of eye
If a patient with type 2 oligoarticular JIA has hip involvement, what antigen is tested for?
HLA-B27, if present, diagnosed with Juvenile spondyloarthritis
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
Asymmetric UL and LL arthritis
Dactylitis- sausage fingers/toes, swelling
In type 3 oligoarthritic JIA, family history of what occurs in approx 40?
FH of psoriasis
Second most common type of JIA?
Polyarticular JIA
Age and sex most likely to develop polyarticular JIA if there is a negative RF (rheumatoid factor)?
->note that most are RF negative
Ang age, often early
Girls > boys
Presentation of polyarticular JIA with negative RF?
Constitutional manifestations e.g. low grade fever, malaise
Hepato-splenomegaly
Mild anaemia
Growth abnormalities
Age and sex most likely to develop polyarticular JIA if there is a positive RF (rheumatoid factor)?
->note that most are RF negative
Late childhood, 12-16yrs
Girls>boys
Presentation of polyarticular JIA with positive RF?
Constitutional manifestations e.g. low grade fever, malaise, weight loss
Anaemia
Rheumatoid nodules
Is uveitis more common in oligoarticular JIA or polyarticular JIA?
Oligoarticular JIA
What subtype of JIA is the most serious in terms of long AND short term morbidity?
Systemic onset of JIA
->systemic symptoms can delay diagnosis
Features of systemic onset JIA?
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
Diagnosis of JIA?
History and examination based
Some bloods
If doing bloods if suspecting JIA, what would you expect to see?
Elevated ESR
->very high in systemic JIA which can be confusing when unsure of diagnosis as does not correlate with disease activity
Rheumatoid factor is positive in what % of polyarticular JIA patients?
15-20%
ANA is positive in what % of oligoarticular JIA patients?
60%
->seen in 75% of any JIA
RECAP- investigation to confirm joint inflammation?
MRI
Ultrasound
First line therapy for JIA?
Simple analgesics
NSAIDs
Second line therapy for oligoarticular JIA?
Can respond well to NSAIDs/joint injections
Methotrexate
Anti-TNF therapies if methotrexate fails
Systemic steroids have limited use due to serious side effects. When would they be used in JIA?
Systemic JIA to control pain and fever
What are some of the risks of systemic steroids?
Osteoporosis, infections, growth abnormalities
Treatment for the uveitis in patients with oligoarticular JIA?
Topical steroids
What are other features of management in a child with JIA?
Family support
School support
Rehabilitation; physio and OT
What is the role of surgery in JIA?
Reconstructive/ joint replacement therapy if out of control
