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Paediatrics > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

What are features of juvenile idiopathic arthritis?

A
  • arthritis for at least 6 weeks
  • morning stiffness
  • irritability or refusal to walk in toddlers
  • school absence or limited ability to participate in physical activity
  • rash/fever
  • fatigue
  • poor appetite/ weight loss
  • delayed puberty
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2
Q

What would be included in a differential diagnosis of JIA?

A
  • Septic arthritis
  • Transient synovitis
  • Malignancies i.e lymphoma, neuroblastoma, bone tumours
  • Recurrent haemarthrosis - haemophiliacs
  • Vascular abnormalities
  • Trauma
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3
Q

What are signs of JIA?

A
  • Swelling:periarticular soft tissue edema/intraarticular effusion/hypertrophy of synovial membrane
  • Tenosynovitis(swollen tendons)
  • pain
  • Joint held in position of maximum comfort
  • range of motion limited at extremes.
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4
Q

What pattern of onset can be noticed of JIA?

A
  • onset early on is most common and will mostly affect girls

- late childhood onset of JIA tends to affect boys over age of 8

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5
Q

What are the 5 main types of JIA?

A
  • oligoarthritis
  • polyarthritis
  • enthesitis related JIA
  • psoriatic arthritis
  • systemic onset arthritis
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6
Q

What is the most common type of JIA?

A

oligoarthritis

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7
Q

What are features of oligoarthritis?

A
  • usually affects one or both knees
  • chronic anterior uveitis common in this type
  • in children with late onset will be negative for ANA
  • children with early onset will be positive for ANA
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8
Q

What prognosis is there for oligoarthritis?

A

usually goes away over time with no longterm problems

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9
Q

What is polyarthritis?

A

multiple joints affected by arthritis

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10
Q

What are symptoms of polyarthritis?

A
  • Painful swelling in fingers, toes, wrists, ankles, hips, knees, the neck and jaw.
  • lethargy
  • fatigue
  • fever
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11
Q

What blood test might be performed on identification of poly arthritis?

A

look for rheumatoid factor

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12
Q

What is the prognosis of polyarthritis?

A

Symptoms may continue into adult life, but it can go into remission, where all the symptoms disappear.

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13
Q

What is enthesitis related JIA?

A

arthritis that affects the places where the tendons attach to the bone (entheses), causing inflammation.

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14
Q

What are signs/symptoms of enthesitis related JIA?

A
  • inflammatory spinal pain
  • sacroiliac koint tenderness
  • HLA B27 positivity
  • acute anterior uveitis
  • family history
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15
Q

What genetic involvements is there in enthesitis related JIA?

A

There may be a family history of ankylosing spondylitis or inflammatory bowel disease because of a particular genetic marker called HLA-B27.

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16
Q

What is psoriatic arthritis?

A

Psoriasis is a skin rash. A combination of joint pain and the rash is known as psoriatic arthritis.

17
Q

What are features of psoriatic arthritis?

A
  • Usually affects fingers and toes but may affect other joints too.
  • Joints may be affected before the psoriasis appears.
  • Painless uveitis
  • onchylosis (nail pitting)
  • all are HLA B27 positive
18
Q

What is the prognosis of psoriatic arthritis?

A

30-40% cases can progress into adulthood

19
Q

What is systemic onset arthritis?

A

Joint pain is part of a general illness involving a fever, tiredness, a rash, loss of weight and appetite.

20
Q

What are features of systemic onset arthritis?

A
  • lymphadenopathy
  • splenomegaly
  • hepatomegaly
  • pericarditis
  • in first few weeks may to be any signs of swollen joints so diagnosis can be uncertain for a while
21
Q

What is the prognosis of systemic onset arthritis?

A

Outlook can be difficult to predict but usually the fever and rash will settle, although the arthritis may continue for several years before settling.

22
Q

How is the diagnosis of JIA made?

A
  • history
  • physical examination findings e.g. GALS
  • investigations
23
Q

What sort of examinations would be done?

A
  • labs e.g bloods (FBC, RF, CRP etc)
  • plain x ray
  • US
  • MRI with contrast
24
Q

What treatments are available for JIA?

A
  • intra-articular steroids
  • if IA steroids don’t work then will consider DMARDS -methotrexate
  • failure to respond to IA steroids or DMARDS then will use biologic agents (anti-tif agents commonly used)
25
Q

In which type of arthritis is uveitis common?

A

oligoarthritis JIA

26
Q

How does uveitis present?

A
  • red eyes
  • headache
  • reduced vision
27
Q

What are complications of uveitis?

A
  • cataracts
  • glaucoma
  • blindness
28
Q

How is uveitis screened for in JIA?

A

using slit lamp

29
Q

What is the treatment of uveitis?

A
  • initially topical steroids to reduce inflammation

- may consider DMARDS e.g. methotrexate or biologics if poor response to steroids

Paediatrics (25 decks)

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