juvenile idiopathic arthritis Flashcards
What is juvenile idiopathic arthritis
Group of systemic inflammatory disorders which affects children below 16 years old
What are the criteria which have to be checked for the diagnosis of juvenile idiopathic arthritis
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
What are the 3 main categories of juvenile idiopathic arthritis
Oligoarticular - less than 5 joints - pauciarticular
Polyarticular - 5 or more joints involved
systemic onset - patient is systemically unwell
What is the most common subtype of juvenile idiopathic arhthritis
Oligoarticular JIA - less than 5 joints involved
How does type 1 oligoarticular JIA present
limp rather than pain in a female toddler age
Who is oligoarticular JIA type 1 more common in
females
before 5 years (preschool age)
What joints does type one JIA affect more
Lower limb - knee>ankle> hand and elbow
Hip is very rare
What antibody can be checked for in type one JIA
ANA - anti-nuclear antibody
What is a common ocular presentation in type 1 JIA
Chronic uveitis which is asymptomatic usually - presents with gradual loss of vision
Who does oligoarticular JIA type 2 commonly present in
school aged boys - 8-9 years old commonly
How does oligoarticular JIA type 2 present
Rarely ill
Limp in the lower limb
Heel pain
Which joints are commonly affected in JIA type 2
Knee and ankle
What genes should be checked for in oligoarticular type 2
HLA-B27 - there will also be back involvement categorised as Juvenile ankylosing spondylitis
Who is most commonly affected by oligoarticular JIA type 3
Any age during childhood and more girls compared to boys
What is the presentation of oligoarticular JIA type 3
Rarely ill
asymmetric upper or lower limb arthritis
dactylitis - inflammation of the digits
cHRONIC UVEITIS
What are the features of type 3 oligoarticular JIA
arthritis can be destructive
family history of psoriasis and can develop psoriasis later in life
Patient may have nail pitting
What is extended oligoarthritis
Presents with oligoarthritis which goes on to affect more than 5 joints becoming polyarticular
What are the two types of polyarticular JIA
Rheumatoid factor +ve - Juvenile rheumatoid
or
Rheumatoid factor -ve - JIA polyarthritis seronegative
Who does JIA polyarthritis serum negative most commonly occur in
Any age but mainly female
What is the presentation of JIA polyarthritis serum negative
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
Who is juvenile rheumatoid more common in
Late childhood (12-16)
and females
How does juvenile rheumatoid present
Systemically unwell
anemia
nodules
Who is systemic onset JIA more common in
Girls slightly more than boys
throughout childhood - 4-6
What is the presentation of systemic onset JIA
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
Describe the rash in systemic onset JIA
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
Who is most at risk of eye disease in JIA
Preschool age girl - type one oligoarthritis JIA - especially if ANA positive
What is the first line treatments of JIA
Simple analgesics
NSAIDS
What is the 2nd line treatment of JIA
Methotrexate
Anti-TNF alpha therapy - if methotrexate is not effective
What is the surgical treatment for JIA
synovectomy
Reconstructive / joint replacement therapy
