Juvenile Idiopathic Arthritis Flashcards
What are features of juvenile idiopathic arthritis?
- 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
What would be included in a differential diagnosis of JIA?
- Septic arthritis
- Transient synovitis
- Malignancies i.e lymphoma, neuroblastoma, bone tumours
- Recurrent haemarthrosis - haemophiliacs
- Vascular abnormalities
- Trauma
What are signs of JIA?
- 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.
What pattern of onset can be noticed of JIA?
- onset early on is most common and will mostly affect girls
- late childhood onset of JIA tends to affect boys over age of 8
What are the 5 main types of JIA?
- oligoarthritis
- polyarthritis
- enthesitis related JIA
- psoriatic arthritis
- systemic onset arthritis
What is the most common type of JIA?
oligoarthritis
What are features of oligoarthritis?
- 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
What prognosis is there for oligoarthritis?
usually goes away over time with no longterm problems
What is polyarthritis?
multiple joints affected by arthritis
What are symptoms of polyarthritis?
- Painful swelling in fingers, toes, wrists, ankles, hips, knees, the neck and jaw.
- lethargy
- fatigue
- fever
What blood test might be performed on identification of poly arthritis?
look for rheumatoid factor
What is the prognosis of polyarthritis?
Symptoms may continue into adult life, but it can go into remission, where all the symptoms disappear.
What is enthesitis related JIA?
arthritis that affects the places where the tendons attach to the bone (entheses), causing inflammation.
What are signs/symptoms of enthesitis related JIA?
- inflammatory spinal pain
- sacroiliac koint tenderness
- HLA B27 positivity
- acute anterior uveitis
- family history
What genetic involvements is there in enthesitis related JIA?
There may be a family history of ankylosing spondylitis or inflammatory bowel disease because of a particular genetic marker called HLA-B27.
What is psoriatic arthritis?
Psoriasis is a skin rash. A combination of joint pain and the rash is known as psoriatic arthritis.
What are features of psoriatic arthritis?
- 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
What is the prognosis of psoriatic arthritis?
30-40% cases can progress into adulthood
What is systemic onset arthritis?
Joint pain is part of a general illness involving a fever, tiredness, a rash, loss of weight and appetite.
What are features of systemic onset arthritis?
- lymphadenopathy
- splenomegaly
- hepatomegaly
- pericarditis
- in first few weeks may to be any signs of swollen joints so diagnosis can be uncertain for a while
What is the prognosis of systemic onset arthritis?
Outlook can be difficult to predict but usually the fever and rash will settle, although the arthritis may continue for several years before settling.
How is the diagnosis of JIA made?
- history
- physical examination findings e.g. GALS
- investigations
What sort of examinations would be done?
- labs e.g bloods (FBC, RF, CRP etc)
- plain x ray
- US
- MRI with contrast
What treatments are available for JIA?
- 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)
In which type of arthritis is uveitis common?
oligoarthritis JIA
How does uveitis present?
- red eyes
- headache
- reduced vision
What are complications of uveitis?
- cataracts
- glaucoma
- blindness
How is uveitis screened for in JIA?
using slit lamp
What is the treatment of uveitis?
- initially topical steroids to reduce inflammation
- may consider DMARDS e.g. methotrexate or biologics if poor response to steroids