Juvenile Idiopathic Arthritis Flashcards
What is Juvenile Idiopathic Arthritis?
Group of systemic inflammatory disorders affecting children below age of 16 years.
The duration of the arthritis must be a minimum of 6 weeks, and all other causes of arthritis (such as infection) must be excluded.
What types of onset can JIA be classfied into?
- Oligoarticular - 1-4 joints affected
- Polyarticular - >/= 5 joints affected in the first 6 months
- Systemic - features such as fever and rash at presentation
- Psoriatic Arthritis
- Enthesitis-related arthritis
- Undifferentiated
What sex and age group does oligoarticular arthritis affect?
- More common in young girls
- Age range - 4-6 yrs
How does Oligoarticular JIA commonly present?
- Arthritis - Knee most common; Wrists and ankles also likely to be involved
- Abnormal Gait/limp - either due to pain or due to muscle wasting
-
Eye disease - anterior uveitis/iridocyclitis - 20% of
- Often asymptomatic - NEED TO CHECK IF SUSPECTED JIA!!!
How does RF negative Polyarticular JIA commonly present?
- Arthritis - symmetrical, may affect DIP, which RF positive NEVER does
- Constitutional manifestations - Low Grade Fever, Malaise
- Hepatosplenomegaly
- Mild Anaemia
- Growth Abnormalities
What is the presentation of RF positive Polyarticular JIA?
- Arthritis- behaves a lot like RA
- Low grade fever
- Malaise
- Weight loss
- Anaemia
- Nodules
What is the presentation of Enthesitis Related JIA?
-
Enthesitis - inflammation at a site where ligament, tendon or fascia attaches to bone
- Common in the foot - particularly calcaneal enthesis
- Peripheral oligoarthritis - usually in the lower limb
- Limping gait
What is the presentation of Juvenile-onset Psoriatic arthritis?
- FH of psoriasis - may not have the typical psoriatic rash at the time of diagnosis
- Nail pitting
- Dactylitis
-
Oligoarthritis - either of the knees or ankles, or of the IP joints of the fingers and toes
- ASYMMETRIC UL/LL arthritis
What is the presentation of Systemic Onset JIA (Stills Disease)?
- High spiking fever
- Transient episodic erythematous rash - Salmon red - on trunk and thighs. Can be brought on by scratching
- Generalised lymphadenopathy
- Hepatosplenomegaly
- Polyserositis - Pericarditis, Pleural and Pericardial effusions,
- Arthritis - Within 3-12 months of fever onset - Wrist, knees, ankles cervical spine, hips, TMJ
How would you investigate for JIA?
Clinical Examination - Movement restriction is often most important sign
No specific test for JIA
Consider:
- ANA - oligoarticular
- HLA-B27 - enthesitis-related JIA
- CRP, ESR, WBC, platelets
- RF - polyarticular
- X-ray, MRI
Exclude differential diagnosis
How would you treat JIA?
Drug treatment - early and aggressive treatment
-
Short Term
- NSAID
- Intraarticular joint steroids - single joint involvement
- Systemic steroids - polyarticular JIA
-
Long Term
- DMARD - Methotrexate, Biologics
Surgical treatment - Synovectomy, Reconstructive/Joint Replacement Surgery
What are the complications of JIA?
- Altered growth of limbs
- Scoliosis
- Short stature
- Joint damage / destruction
- Blindness(untreated uveitis)
- Psychosocial effects of chronic disease
- Loss of schooling
What is the differential diagnosis for children presenting with symptoms associated JIA?
THIS LIST DEMONSTRATES JUST HOW MANY THINGS IT COULD BE
- Septic arthritis
- Reactive arthritis
- Rheumatic fever
- Associated with IBD
- Connective tissue disorder:
- SLE, Juvenile Dermatomyositis, Connective tissue disorder
- Mechanical joint pain (hypermobility)
- Growing pain
- Leukaemia
- Neuroblastoma
- Primary bone tumour
- Perthe’s disease
- Slipped upper femoral epiphysis
- Congenital hip dysplasia
- Fracture
- Trauma
- Referred pain
What general measures should be taken in the overal treatment of a child with JIA?
- Physio + OT
- Psychology
- Family, School/peer group - encourage normal activity
What complications should be screened for in children with JIA?
- Uveitis - Regular opthalmologist review
- Contractures
