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Year 3 MSK (JK) > Juvenile idiopathic arthritis > Flashcards

Juvenile idiopathic arthritis Flashcards

1
Q

Define JIA

A

Group of systemic inflammatory disorders affecting children below the age of 16

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2
Q

Why is JIA important to recognise?

A

most commonly diagnosed rheumatic disease In children

important cause of disability and blindness

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3
Q

History of JIA

A

Cornil 1864 - juvenile onset RA
12 years, polyarticular and dead by 29
peritonitis, pleurisy, renal disease –> amyloidosis?

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4
Q

Who helped to categorise JIA?

A

George Frederic still in 1896

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5
Q

aetiopathogenesis of JIA

A

autoimmune disease and multi-factorial

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6
Q

Age of onset

A

under 16

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7
Q

Duration of disease

A

more than 6 weeks

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8
Q

presence of arthritis in JIA

A

joint swelling or 2 of

1. painful or limited ROM 2. tenderness 3. warmth

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9
Q

What investigations are used to confirm arthritis?

A

USS or MRI

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10
Q

After how long from onset can 3 subtypes of JIA be identified?

A

6

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11
Q

3 subtypes of JIA and %

A

pauciarticular - 55%
polyarticular - 25%
systemic onset - 20%

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12
Q

3 types of pauciarticular JIA and %

A

type 1 - 25
type 2 - 15
type 3 - 15

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13
Q

Who does type 1 pauciarticular JIA affect?

A

pre-school aged girl

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14
Q

presentation of type 1 pauciarticular JIA

A

limp due to lower limb involved - knee >ankle>hand
chronic uveitis in 20% –> 95% if female under 2yrs
asymptomatic in 50%
posterior synechiae = irregular iris
positive ANA in 40-75%

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15
Q

Who does type 2 pauciarticular JIA affect?

A

after 8-9 years, BOYS

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16
Q

presentation of type 2 pauciarticular JIA

A

limp - lower limb (knee and ankle)

hip can be affected early with rapid damage

17
Q

categorising type 2 pauciarticular JIA

A

Canadians - no back involvement = SEA

HLA-B27 and +ve back = juvenile AS

18
Q

type 2 pauciarticular JIA iridocyclitis

A

acute in 10-20%

19
Q

Who does type 3 pauciarticular JIA affect?

A

any age in childhood, girls

FH of psoriasis

20
Q

presentation of 3 pauciarticular JIA

A

asymmetric UL and LL
dactylitis
chronic iridocyclitis in 10-20%
nail pitting

21
Q

who does RF -ve polyarticular JIA affect?

A

any age - often early, girls

22
Q

symptoms of RF -ve polyarticular JIA

A

constitutional = low grade fever, malaise, anaemia
hepato-splenomegaly, growth abnormalities
symmetric large and small joints

23
Q

who does RF +ve polyarticular JIA affect?

A

12-16 years, girls

24
Q

symptoms of RF +ve polyarticular JIA

A

constitutional symptoms, anaemia, nodules

25
Q

What can RF +ve polyarticular JIA be complicated by?

A

sjogrens, vasculitis, pulmonary fibrosis etc

26
Q

RF +ve polyarticular JIA x-ray

A

erosions appear early

27
Q

systemic JIA - when do extra-articular features start?

A

early and disappear after 2-5yrs

28
Q

systemic JIA - who does it affect?

A

4-6years, equal boys and girls

29
Q

Systemic JIA features - summary

A

fever - 39.5 for 2 weeks high in afternoon
rash - 90% salmon red on trunk and thighs
arthritis - 12 months from fever onset
LN - general non tender lymphadenopathy
Abdo - pain, hepatosplenomegaly
serositis - polyserositis, 36% pericarditis
pulmonary - pleural effusion/fibrosis rare

30
Q

1st line therapy

A

simple pain killers

NSAIDS

31
Q

2nd line therapy

A

no response to NSAID/joint injection
methotrexate
Anti-TNF
IL-1/6 antagonist for systemic

32
Q

When would systemic steroids be used? (4)

A

systemic JIA - pain and fever
serious complications
kids undergoing surgery
bridge for DMARDs

33
Q

Risks of systemic steroids

A

osteoporosis, infections, growth abnormalities

34
Q

Local steroids

A

intra-articular or eye disease oligo-articular JIA

35
Q

Other treatment

A

rehab - physio and OT

36
Q

surgery

A

synovectomy

reconstructive/joint replacement

Year 3 MSK (JK) (30 decks)

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