Juvenile idiopathic arthritis

Question 1

What is JIA?

Answer 1

Group of systemic inflammatory disorders affecting children below 16

Question 2

What is the pathogenesis of JIA?

Answer 2

Autoimmune

Genetic markers

Question 3

What is the criteria for diagnosis of JIA?

Answer 3

Onset <16
Duration of disease >6 weeks
Presence of arthritis- joint swelling or 2 of: painful or limited joint movement, tenderness, warmth

Question 4

What are the types of JIA?

Answer 4

Periarticular
Polyarticular
Systemic

Question 5

What is periarticular JIA?

Answer 5

Affects 4 joints or less

Question 6

What are the types of periarticular JIA?

Answer 6

Type 1, 2 and 3

Question 7

What is type 1 periarticular JIA?

Answer 7

Majority girls, presents before age 5, normally age 1-3

Question 8

What is the presentation of type 1 periarticular JIA?

Answer 8

Limp due to arthritis normally in knee or ankle
Asymptomatic in 50%
Chronic uveitis in 20%
Irregular iritis
\+ ANA in 40-75%

Question 9

What is type 2 periarticular JIA?

Answer 9

Mainly boys

Onst after 8 years

Question 10

What is the presentation of type 2 periarticular JIA?

Answer 10

Limp due to mainly knee and ankle, but occasionally hip

Acute iridocyclitis in 10-20%

Question 11

What is type 3 periarticular JIA?

Answer 11

Mainly girls

Onset at any age in childhood

Question 12

What is the presentation of type 3 periarticular JIA?

Answer 12

Asymmetric upper and lower limb arthritis
Dactylitis
Nail pitting
Psoriasis- FH in 40%
Chronic iridocyclitis in 10-20%

Question 13

What is polyarticular JIA?

Answer 13

5 or more joints affected

Question 14

What are the types of polyarticualr JIA?

Answer 14

Rheumatic factor -

Rheumatic factor +

Question 15

When does rheumatic - JIA present?

Answer 15

Any age but often earlier

Question 16

Who is rheumatic - JIA seen in?

Answer 16

Mainly girls

Question 17

What is the presentation of rheumatic - JIA?

Answer 17

Behaves like rheumatoid arthritis in adults
Symmetric
Large and small joints affected
Systemic- fever, malaise
Hepatosplenomegaly
Mild anaemia
Growth abnormalities

Question 18

What is the presentation of rheumatic + JIA?

Answer 18

Systemic- fever, malaise, weight loss
Anaemia
Nodules
Early erosions on xray

Question 19

Who is rheumatic + JIA seen in?

Answer 19

Mainly girls

Later onset, 12-16 years

Question 20

What is systemic onset JIA?

Answer 20

Least common but most dangerous form

Question 21

Who is systemic onset IA seen in?

Answer 21

4-6 year olds

Slightly more girls- 3:2

Question 22

What is the presentation of systemic JIA?

Answer 22

Any joint, starting 3-12 months after onset of fever
Fever- high and persistent and worse in evening
Generalised non tender lymphadenopathy in 50-75%
Salmon pink rash on trunk and thighs in 90%
Polyserositis
Pericarditis
Hepatosplenomegaly and abode pain in 50-75%

Question 23

What are the rare presentations of systemic JIA?

Answer 23

Pleural effusion
Pulmonary fibrosis
Tamponade
Myocarditis

Question 24

How is systemic JIA diagnosed?

Answer 24

Exclusion

Question 25

What is the 1st line treatment of JIA?

Answer 25

NSAIDs Local steroids Physio OT

Question 26

When and how are steroids used in JIA?

Answer 26

Joint steroid injections, mainly in oligoarticular disease | Eye disease

Question 27

What are the 2nd line pharm treatments of JIA?

Answer 27

``` Methotrexate Anti TNF IL-1 R antagonist IL-6 antagonist Systemic steroids ```

Question 28

When are IL-1 R antagonists and IL-6 antagonists used?

Answer 28

Refractory systemicc disease

Question 29

What are the indications for steroid use in JIA?

Answer 29

Systemic disease Serious disease complications Undergoing surgery

Question 30

What are the risks of using steroids in JIA?

Answer 30

Osteoporosis Infections Growth abnormalities

Question 31

What are the surgical options in JIA?

Answer 31

Synovectomy | Reconstructive/joint replacement