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Paediatric Interventions > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

What are the 3 categories of childhood rheumatic diseases?

A
  • Inflammatory joint diseases (JIA)
  • Connective tissues diseases
  • Non-inflammatory pain
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2
Q

What is juvenile idiopathic arthritis (JIA)?

A
  • Diverse group of immune-mediated disorders affected children <16
  • Swelling or limitation of ROM accompanied by heat, pain or tenderness
  • Lasts at least 6 weeks
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3
Q

What are the differential diagnoses that need to be excluded when diagnosing JIA?

A
  • Infection
  • Orthopaedic (Perthes, AVN, SCFE)
  • Mechanical
  • Reactive
  • Hypermobility
  • Other inflammatory (SLE, JDM, scleroderma)
  • Malignancy
  • Pain syndromes
  • Rheumatic fever
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4
Q

What are the clinical signs of JIA?

A
  • Swelling
  • Pain
  • Warmth around the joint
  • Fever
  • Joint stiffness esp. AM
  • Irritability
  • Loss of ROM
  • Contracture
  • Muscle atrophy
  • Limping
  • Arthralgia
  • Fatigue
  • Growth asymmetry
  • Joint destruction
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5
Q

What blood tests are used to detect JIA?

A
  • FBC: Infection, anaemia
  • ESR: Inflammation
  • CRP: Inflammation
  • ANA: Linked to uveitis
  • RF: Associated with adult RA
  • HLA B27: Often present in enthesitis-related arthritis
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6
Q

What imaging is used to detect JIA?

A
  • Xray
  • Ultrasound
  • MRI
  • Bone scan
  • Arthroscopy
  • ECG
  • Bone densitometry
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7
Q

What are the subgroups of JIA?

A
  • Oligoarticular/pauciarticular
  • Polyarticular
  • Less common types
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8
Q

What are some of the less common types of JIA?

A
  • Systemic arthritis
  • Enthesitis-related arthritis
  • Psoriatic arthritis
  • Unclassified (doesn’t fit any category)
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9
Q

What is the pathophysiology of JIA?

A
  • Synovial joint lining becomes inflamed & thinkened
  • Causes pain, redness, swelling, AM stiffness
  • If untreated, can damage the articular cartilage & surrounding bone
  • Muscles around the joint become weak
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10
Q

What are the characteristics of oligoarticular JIA?

A
  • Affects 4 joints or less
  • 50-60% of JIA children
  • 80% ANA positive
  • Affects more females than males (5:1)
  • Asymmetric large joints
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11
Q

What are the characteristics of polyarticular JIA?

A
  • Affects 5 joints or more
  • 30% of JIA children
  • 50% ANA positive
  • RF positive (3-5%) or RF negative (20-30%)
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12
Q

What is the difference between RF positive & RF negative polyarticular JIA?

A

RF positive:

  • Peak onset adolescence
  • Gender 4:1 (F:M)
  • Symmetric multiple small & large joints
  • High incidence C1/2 subluxation

RF negative:

  • Peak onset 1-3 years
  • Gender 9:1 (F:M)
  • Asymmetric multiple small & large joints
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13
Q

What are the characteristics of systemic JIA?

A
  • 10-15% of JIA children
  • Gender 1:1
  • Small & large joints
  • Rash & fever daily for 2 weeks
  • Organomegaly (pericarditis, pleural effusion etc)
  • 50% recover completely, 48% active disease 10 years on
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14
Q

What are the characteristics of enthesitis related arthritis (Aka juvenile AS)?

A
  • > 8 years
  • Gender 1:7 (F:M)
  • 80% HLA B27 positive
  • Asymmetric large joints including axial skeleton
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15
Q

What are the characteristics of psoriatic arthritis?

A
  • 7% of JIA children
  • Onset preschool & age 10
  • 70% have ongoing active disease into adulthood
  • 35% HLA B27 positive
  • Small & large joints esp DIPs
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16
Q

What does the management of JIA involve?

A
  • Medications: NSAIDs, corticosteroids, DMARDs, biologics, intra-articular steroid injections
  • Physio
17
Q

What are the goals of physio for JIA?

A
  • Decrease pain
  • Maintain/improve function & lifestyle
  • Educate about disease & its management
  • Maintain/increase ROM & strength
  • Prevent/correct deformity or abnormal movement patterns - Encourage activities that support normal development
  • Maintain/improve exercise endurance & aerobic capacity
  • Address leg length discrepancy
18
Q

What does the physio assessment of JIA involve?

A
  • Pain
  • Function & lifestyle
  • Knowledge of disease
  • ROM
  • Strength/length
  • Deformity & abnormal movement patterns
  • Leg length
  • Normal development
  • Exercise & aerobic capacity
  • Hypermobility
  • Pain
  • CHAQ (childhood health assessment questionnaire)
  • pGALS (paediatric gait arms legs & spine)
19
Q

What are some of the pain-related problems associated with JIA?

A
  • Unacceptable or increasing pain
  • Behaviour or sleep changes
  • Altered function/functional patterns
  • Incomplete knowledge of pain management techniques
  • Ergonomic, cognitive behavioural & biomechanical triggers
  • Biomechanical malalignment
  • Pain syndrome overlap
20
Q

What are some of the pain treatment options?

A
  • Heat/ice
  • Joint protection ergonomics
  • Pain team referral (NSW)
  • Splinting
  • Orthotics
  • Self management techniques (relaxation)
  • Pacing & positioning
21
Q

What should be measured when assessing function?

A
  • Functional restrictions in school, self-care & leisure/play
  • Ergonomics at school & home
  • Self management skills (fatigue, sleep hygiene)
  • Developmental milestones
  • Social interaction
22
Q

What are some of the physio treatment options for JIA?

A
  • Education
  • Exercise program (ROM, strength, length, CV fitness)
  • Target problem joints (splinting, orthotics, re-education of faulty movement patterns)
  • Activity pacing
  • Sleep hygiene
  • Ergonomic advice
23
Q

What are the benefits of hydro?

A
  • Reduces pain & muscle spasm
  • Increases ROM
  • Reduces joint stiffness
  • Increases muscle strength
  • Increases aerobic capacity
  • Adds fun element to program
24
Q

What are some of the other considerations for children with JIA?

A
  • School environment (stairs, backpack, chairs etc)
  • Physical activity vs play vs exercise
  • ADLs
  • Handwriting
  • Modifications to activities (rest breaks, equipment modifications)
25
Q

What are some of the activities that can be recommended for children with JIA?

A
  • Roller blading or skating
  • Bike riding and scootering - Hoola hoops
  • Gardening
  • Rock climbing
  • Martial arts
  • Swimming
  • Cubs, Brownies, Scouts
  • Sailing
  • Kayaking
  • Dancing, Yoga, Pilates

Paediatric Interventions (27 decks)

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