Juvenile idiopathic arthritis

Question 1

What is needed for diagnosis of Juvenile idiopathic arthritis

Answer 1

Age of onset < 16
Duration of disease > 6 weeks
Joint swelling or 2 of:
Painful or limited motion, tenderness, warmth

Question 2

Investigations for JIA

Answer 2

ESR increased
ASO increased but no evidence of infection
RF (Poly)
ANA (pauci)

Question 3

What is pauciarticular arthritis

Answer 3

affects 4 or less joints

Question 4

Type 1 pauciarticular features

Answer 4

Age < 5, G > B
Limp presentation
LL joints (Knee > ankle >hand)
\+ve ANA (40-75%)
Chronic uveitis
Irregular iris

Question 5

Type II pauciarticular features

Answer 5

> 8/9, B>G

LL joints mainly

Question 6

Type III pauciarticular

Answer 6

Any age G > B 4:1
Asymmetric UL and LL
Dactilytis
+/- nail pitting

Question 7

What is poly articular JIA

Answer 7

5 or more joints

Can be RF +ve or -ve

Question 8

Features of RF +ve polyarrticular

Answer 8

Late childhood, G > B 
Constitutional manifestations
Anaemia
Nodules
Erosions on x-ray

Question 9

Features of RF -ve polyarticular

Answer 9

Any age, G > B 
Constitutional manifestations
Hepatosplenomegaly
Mild anaemia
Growth abnormal
Symmetric large and small joints

Question 10

What are features of systemic JIA

Answer 10

Fever of more than 39.5 for 2/52
Rash on trunk or thighs
Generalised lymphadenopahty
Abdominal pain

Question 11

Management of JIA

Answer 11

First line painkillers, NSAIDs
Second line if no response to NSAIDs - methotrexate, anti-TNF, Il-Ir or Il-I6 antagonists
Steroids for systemic and serious disease
Physio/Ot
Surgery - synovectomy, reconstructive/replacement