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juvenile idiopathic arthritis Flashcards

1
Q

What is juvenile idiopathic arthritis

A

Group of systemic inflammatory disorders which affects children below 16 years old

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2
Q

What are the criteria which have to be checked for the diagnosis of juvenile idiopathic arthritis

A

Age of onset <16 years old

duration of disease>4 weeks

Presence of arthritis - joint swelling or 2 of the following:
painful limited joint motion
tenderness
warmth

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3
Q

What are the 3 main categories of juvenile idiopathic arthritis

A

Oligoarticular - less than 5 joints - pauciarticular
Polyarticular - 5 or more joints involved
systemic onset - patient is systemically unwell

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4
Q

What is the most common subtype of juvenile idiopathic arhthritis

A

Oligoarticular JIA - less than 5 joints involved

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5
Q

How does type 1 oligoarticular JIA present

A

limp rather than pain in a female toddler age

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6
Q

Who is oligoarticular JIA type 1 more common in

A

females
before 5 years (preschool age)

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7
Q

What joints does type one JIA affect more

A

Lower limb - knee>ankle> hand and elbow

Hip is very rare

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8
Q

What antibody can be checked for in type one JIA

A

ANA - anti-nuclear antibody

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9
Q

What is a common ocular presentation in type 1 JIA

A

Chronic uveitis which is asymptomatic usually - presents with gradual loss of vision

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10
Q

Who does oligoarticular JIA type 2 commonly present in

A

school aged boys - 8-9 years old commonly

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11
Q

How does oligoarticular JIA type 2 present

A

Rarely ill
Limp in the lower limb
Heel pain

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12
Q

Which joints are commonly affected in JIA type 2

A

Knee and ankle

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13
Q

What genes should be checked for in oligoarticular type 2

A

HLA-B27 - there will also be back involvement categorised as Juvenile ankylosing spondylitis

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14
Q

Who is most commonly affected by oligoarticular JIA type 3

A

Any age during childhood and more girls compared to boys

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15
Q

What is the presentation of oligoarticular JIA type 3

A

Rarely ill
asymmetric upper or lower limb arthritis
dactylitis - inflammation of the digits

cHRONIC UVEITIS

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16
Q

What are the features of type 3 oligoarticular JIA

A

arthritis can be destructive

family history of psoriasis and can develop psoriasis later in life

Patient may have nail pitting

17
Q

What is extended oligoarthritis

A

Presents with oligoarthritis which goes on to affect more than 5 joints becoming polyarticular

18
Q

What are the two types of polyarticular JIA

A

Rheumatoid factor +ve - Juvenile rheumatoid

or

Rheumatoid factor -ve - JIA polyarthritis seronegative

19
Q

Who does JIA polyarthritis serum negative most commonly occur in

A

Any age but mainly female

20
Q

What is the presentation of JIA polyarthritis serum negative

A

Because of the number of inflamed joints, patient may be systemically unwell

Hepato-spleomegaly

anemia

growth abnormalities

symmetric large and small joints

Uveitis is rare

21
Q

Who is juvenile rheumatoid more common in

A

Late childhood (12-16)
and females

22
Q

How does juvenile rheumatoid present

A

Systemically unwell

anemia

nodules

23
Q

Who is systemic onset JIA more common in

A

Girls slightly more than boys

throughout childhood - 4-6

24
Q

What is the presentation of systemic onset JIA

A

Arthritis - can take a year to appear
rash - salmon red eruption of non raised rash (macules)
fever - >39.5 for more than 2 weeks
sore throat in absence of infection
abdominal pain
lymphadenopathy
weight loss
very unwell in late afternoon and night

25
Q

Describe the rash in systemic onset JIA

A

quickly fading, salmon red eruption on the trunk and thighs that comes with a fever

The rash comes on with scratching - positive Koebner’s phenomenon

26
Q

Who is most at risk of eye disease in JIA

A

Preschool age girl - type one oligoarthritis JIA - especially if ANA positive

27
Q

What is the first line treatments of JIA

A

Simple analgesics

NSAIDS

28
Q

What is the 2nd line treatment of JIA

A

Methotrexate

Anti-TNF alpha therapy - if methotrexate is not effective

29
Q

What is the surgical treatment for JIA

A

synovectomy

Reconstructive / joint replacement therapy

MSK (36 decks)

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