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MSK AM > Juvenile idiopathic arthritis > Flashcards

Juvenile idiopathic arthritis Flashcards

1
Q

What is JIA?

A

Group of systemic inflammatory disorders affecting children below 16

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2
Q

What is the pathogenesis of JIA?

A

Autoimmune

Genetic markers

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3
Q

What is the criteria for diagnosis of JIA?

A

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

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4
Q

What are the types of JIA?

A

Periarticular
Polyarticular
Systemic

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5
Q

What is periarticular JIA?

A

Affects 4 joints or less

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6
Q

What are the types of periarticular JIA?

A

Type 1, 2 and 3

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7
Q

What is type 1 periarticular JIA?

A

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

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8
Q

What is the presentation of type 1 periarticular JIA?

A 
Limp due to arthritis normally in knee or ankle
Asymptomatic in 50%
Chronic uveitis in 20%
Irregular iritis
\+ ANA in 40-75%
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9
Q

What is type 2 periarticular JIA?

A

Mainly boys

Onst after 8 years

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10
Q

What is the presentation of type 2 periarticular JIA?

A

Limp due to mainly knee and ankle, but occasionally hip

Acute iridocyclitis in 10-20%

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11
Q

What is type 3 periarticular JIA?

A

Mainly girls

Onset at any age in childhood

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12
Q

What is the presentation of type 3 periarticular JIA?

A 
Asymmetric upper and lower limb arthritis
Dactylitis
Nail pitting
Psoriasis- FH in 40%
Chronic iridocyclitis in 10-20%
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13
Q

What is polyarticular JIA?

A

5 or more joints affected

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14
Q

What are the types of polyarticualr JIA?

A

Rheumatic factor -

Rheumatic factor +

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15
Q

When does rheumatic - JIA present?

A

Any age but often earlier

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16
Q

Who is rheumatic - JIA seen in?

A

Mainly girls

17
Q

What is the presentation of rheumatic - JIA?

A 
Behaves like rheumatoid arthritis in adults
Symmetric
Large and small joints affected
Systemic- fever, malaise
Hepatosplenomegaly
Mild anaemia
Growth abnormalities
18
Q

What is the presentation of rheumatic + JIA?

A

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

19
Q

Who is rheumatic + JIA seen in?

A

Mainly girls

Later onset, 12-16 years

20
Q

What is systemic onset JIA?

A

Least common but most dangerous form

21
Q

Who is systemic onset IA seen in?

A

4-6 year olds

Slightly more girls- 3:2

22
Q

What is the presentation of systemic JIA?

A

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%

23
Q

What are the rare presentations of systemic JIA?

A

Pleural effusion
Pulmonary fibrosis
Tamponade
Myocarditis

24
Q

How is systemic JIA diagnosed?

A

Exclusion

25
Q

What is the 1st line treatment of JIA?

A

NSAIDs
Local steroids
Physio
OT

26
Q

When and how are steroids used in JIA?

A

Joint steroid injections, mainly in oligoarticular disease

Eye disease

27
Q

What are the 2nd line pharm treatments of JIA?

A 
Methotrexate
Anti TNF
IL-1 R antagonist
IL-6 antagonist
Systemic steroids
28
Q

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

A

Refractory systemicc disease

29
Q

What are the indications for steroid use in JIA?

A

Systemic disease
Serious disease complications
Undergoing surgery

30
Q

What are the risks of using steroids in JIA?

A

Osteoporosis
Infections
Growth abnormalities

31
Q

What are the surgical options in JIA?

A

Synovectomy

Reconstructive/joint replacement

MSK AM (37 decks)

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