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Musculoskeletal > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

What is JIA?

A

Juvenile Idiopathic Arthritis

An umbrella term for a number of types of autoimmune arthritis that occur in children under age 17

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2
Q

In general what are the clinical features of JIA?

A

Joint swelling
Stiffness
Limitation
Occurs for longer than 6 weeks

Young children don’t complain of pain they just stop using the affected joint

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3
Q

How many types of JIA are there?

Name them!

A

Seven types

  1. Persistent Oligoarthritis
  2. Extended Oligoarthritis
  3. Rh factor -ve
  4. Rh positive +ve
  5. Enthesitis related
  6. Psoriatic arthritis
  7. Still’s disease (systemic)
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4
Q

Clinical features of persistent Oligoarthritis?

A

1-4 (a few) joints affected
Usually the knees are involved

Joints are painful, stiff, restricted

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5
Q

Who gets persistent Oligoarthritis?

A

Usually children under age 6

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6
Q

What would you usually find looking at serology of a child with persistent Oligoarthritis?

A

ANA positive

Anti-nuclear antibodies

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7
Q

What is it VITAL to consider in all children with any type of JIA?

A

Patients with JIA have a high risk of developing anterior uveitis

They need to be screened every 3 months until they are old enough that they’ll complain of blurry vision

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8
Q

Clinical features of extended Oligoarthritis?

A

1-4 joints affected in first 6 months
After that more are affected

Joints are painful, stiff, restricted

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9
Q

Who gets extended Oligoarthritis?

A

Peak age is between 2 and 4

Girls more frequently than boys

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10
Q

What are the chances that the child will grow out of:

  • persistent Oligoarthritis
  • extended Oligoarthritis?
A

Persistent: good chance, good prognosis

Extended: not as good a chance, worse prognosis

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11
Q

Clinical features of Rh factor negative JIA?

A

Acute or insidious progression

Affects at least 5 joints

Usually symmetrical

Also low grade systemic features:

  • fever
  • anaemia / thrombocytosis
  • malaise
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12
Q

Clinical features of Rh positive JIA?

A

Very similar to adult RA

Symmetrical joints affected

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13
Q

Who gets Rh positive JIA?

A

Girls more than boys

Often starts in adolescence

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14
Q

Clinical features of Enthesitis related JIA?

A

Inflammatory back pain or sacroiliac pain

Similar to adult Ankylosing Spondylitis

Links with IBD

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15
Q

Who gets Enthesitis related JIA?

A

Boys more than girls

Over age 6, peak age 10-12

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16
Q

When would you diagnose psoriatic arthritis?

A

If you see JIA in a patient with psoriasis or with a family history of it

17
Q

Clinical features of psoriatic arthritis?

A

Joint pain

Dactylitis (sausage digit) is a classic sign of psoriatic arthritis

18
Q

Clinical features of Still’s disease?

A

Systemic illness:

  • daily fever
  • malaise
  • rash
  • anaemia
  • high platelets
  • lymphadenopathy
  • hepatosplenomegaly

Arthritis presents later

19
Q

Who gets Still’s disease?

A

Any age, peak age 4-6

Equal male and female ratio

20
Q

Which of the JIAs has systemic involvement?

A

Rh factor negative JIA
Enthesitis related JIA
Still’s disease

21
Q

Non-medical treatment of JIA?

A 
Educate the patient + family
Liaison with school
Physiotherapy
Occupational therapy
Psychology
22
Q

Medical treatment of JIA?

A 
Steroid joint injections
NSAIDs
Methotrexate
Systemic steroids
Biologics
23
Q

What happens if you don’t treat JIA properly?

A

Joint damage / deformity / disability

Pain + self-esteem problems

Undergrowth of the jaw

Bony overgrowth: unequal leg length

Anaemia, weight loss, failure to thrive

Uveitis

24
Q

What other diagnosis should you always consider when you suspect a diagnosis of JIA?

A

Leukaemia

Do a blood test to rule it out

25
Q

How would you distinguish Still’s disease from other JIAs?

A

Still’s disease has a serious systemic involvement

Blood tests will show up raised ferritin

Musculoskeletal (15 decks)

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