Juvenile Idiopathic Arthritis Flashcards
What is JIA?
Juvenile Idiopathic Arthritis
An umbrella term for a number of types of autoimmune arthritis that occur in children under age 17
In general what are the clinical features of JIA?
Joint swelling
Stiffness
Limitation
Occurs for longer than 6 weeks
Young children don’t complain of pain they just stop using the affected joint
How many types of JIA are there?
Name them!
Seven types
- Persistent Oligoarthritis
- Extended Oligoarthritis
- Rh factor -ve
- Rh positive +ve
- Enthesitis related
- Psoriatic arthritis
- Still’s disease (systemic)
Clinical features of persistent Oligoarthritis?
1-4 (a few) joints affected
Usually the knees are involved
Joints are painful, stiff, restricted
Who gets persistent Oligoarthritis?
Usually children under age 6
What would you usually find looking at serology of a child with persistent Oligoarthritis?
ANA positive
Anti-nuclear antibodies
What is it VITAL to consider in all children with any type of JIA?
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
Clinical features of extended Oligoarthritis?
1-4 joints affected in first 6 months
After that more are affected
Joints are painful, stiff, restricted
Who gets extended Oligoarthritis?
Peak age is between 2 and 4
Girls more frequently than boys
What are the chances that the child will grow out of:
- persistent Oligoarthritis
- extended Oligoarthritis?
Persistent: good chance, good prognosis
Extended: not as good a chance, worse prognosis
Clinical features of Rh factor negative JIA?
Acute or insidious progression
Affects at least 5 joints
Usually symmetrical
Also low grade systemic features:
- fever
- anaemia / thrombocytosis
- malaise
Clinical features of Rh positive JIA?
Very similar to adult RA
Symmetrical joints affected
Who gets Rh positive JIA?
Girls more than boys
Often starts in adolescence
Clinical features of Enthesitis related JIA?
Inflammatory back pain or sacroiliac pain
Similar to adult Ankylosing Spondylitis
Links with IBD
Who gets Enthesitis related JIA?
Boys more than girls
Over age 6, peak age 10-12
When would you diagnose psoriatic arthritis?
If you see JIA in a patient with psoriasis or with a family history of it
Clinical features of psoriatic arthritis?
Joint pain
Dactylitis (sausage digit) is a classic sign of psoriatic arthritis
Clinical features of Still’s disease?
Systemic illness:
- daily fever
- malaise
- rash
- anaemia
- high platelets
- lymphadenopathy
- hepatosplenomegaly
Arthritis presents later
Who gets Still’s disease?
Any age, peak age 4-6
Equal male and female ratio
Which of the JIAs has systemic involvement?
Rh factor negative JIA
Enthesitis related JIA
Still’s disease
Non-medical treatment of JIA?
Educate the patient + family Liaison with school Physiotherapy Occupational therapy Psychology
Medical treatment of JIA?
Steroid joint injections NSAIDs Methotrexate Systemic steroids Biologics
What happens if you don’t treat JIA properly?
Joint damage / deformity / disability
Pain + self-esteem problems
Undergrowth of the jaw
Bony overgrowth: unequal leg length
Anaemia, weight loss, failure to thrive
Uveitis
What other diagnosis should you always consider when you suspect a diagnosis of JIA?
Leukaemia
Do a blood test to rule it out
How would you distinguish Still’s disease from other JIAs?
Still’s disease has a serious systemic involvement
Blood tests will show up raised ferritin
