Juvenile Idiopathic Arthritis Flashcards
What are the 3 categories of childhood rheumatic diseases?
- Inflammatory joint diseases (JIA)
- Connective tissues diseases
- Non-inflammatory pain
What is juvenile idiopathic arthritis (JIA)?
- 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
What are the differential diagnoses that need to be excluded when diagnosing JIA?
- Infection
- Orthopaedic (Perthes, AVN, SCFE)
- Mechanical
- Reactive
- Hypermobility
- Other inflammatory (SLE, JDM, scleroderma)
- Malignancy
- Pain syndromes
- Rheumatic fever
What are the clinical signs of JIA?
- 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
What blood tests are used to detect JIA?
- FBC: Infection, anaemia
- ESR: Inflammation
- CRP: Inflammation
- ANA: Linked to uveitis
- RF: Associated with adult RA
- HLA B27: Often present in enthesitis-related arthritis
What imaging is used to detect JIA?
- Xray
- Ultrasound
- MRI
- Bone scan
- Arthroscopy
- ECG
- Bone densitometry
What are the subgroups of JIA?
- Oligoarticular/pauciarticular
- Polyarticular
- Less common types
What are some of the less common types of JIA?
- Systemic arthritis
- Enthesitis-related arthritis
- Psoriatic arthritis
- Unclassified (doesn’t fit any category)
What is the pathophysiology of JIA?
- 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
What are the characteristics of oligoarticular JIA?
- Affects 4 joints or less
- 50-60% of JIA children
- 80% ANA positive
- Affects more females than males (5:1)
- Asymmetric large joints
What are the characteristics of polyarticular JIA?
- Affects 5 joints or more
- 30% of JIA children
- 50% ANA positive
- RF positive (3-5%) or RF negative (20-30%)
What is the difference between RF positive & RF negative polyarticular JIA?
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
What are the characteristics of systemic JIA?
- 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
What are the characteristics of enthesitis related arthritis (Aka juvenile AS)?
- > 8 years
- Gender 1:7 (F:M)
- 80% HLA B27 positive
- Asymmetric large joints including axial skeleton
What are the characteristics of psoriatic arthritis?
- 7% of JIA children
- Onset preschool & age 10
- 70% have ongoing active disease into adulthood
- 35% HLA B27 positive
- Small & large joints esp DIPs
What does the management of JIA involve?
- Medications: NSAIDs, corticosteroids, DMARDs, biologics, intra-articular steroid injections
- Physio
What are the goals of physio for JIA?
- 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
What does the physio assessment of JIA involve?
- 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)
What are some of the pain-related problems associated with JIA?
- 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
What are some of the pain treatment options?
- Heat/ice
- Joint protection ergonomics
- Pain team referral (NSW)
- Splinting
- Orthotics
- Self management techniques (relaxation)
- Pacing & positioning
What should be measured when assessing function?
- Functional restrictions in school, self-care & leisure/play
- Ergonomics at school & home
- Self management skills (fatigue, sleep hygiene)
- Developmental milestones
- Social interaction
What are some of the physio treatment options for JIA?
- 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
What are the benefits of hydro?
- Reduces pain & muscle spasm
- Increases ROM
- Reduces joint stiffness
- Increases muscle strength
- Increases aerobic capacity
- Adds fun element to program
What are some of the other considerations for children with JIA?
- School environment (stairs, backpack, chairs etc)
- Physical activity vs play vs exercise
- ADLs
- Handwriting
- Modifications to activities (rest breaks, equipment modifications)
What are some of the activities that can be recommended for children with JIA?
- Roller blading or skating
- Bike riding and scootering - Hoola hoops
- Gardening
- Rock climbing
- Martial arts
- Swimming
- Cubs, Brownies, Scouts
- Sailing
- Kayaking
- Dancing, Yoga, Pilates
