Juvenile Idiopathic Arthritis Flashcards
3 types of JIA
Oligoarticular (55%)
Polyarticular (25%)
Systemic onset (20%
What is the most commonly diagnosed Rheumatic disease in children
Juvenile Idiopathic Arthritis
Describe pauciarticlar JIA
Most common type
4 or less joint involvement
Describe polyarticular JIA
how many joints and what % RF +ve/-ve
5 or more joint involvement
15% RF -ve
10% RF +ve
1st line Rx JIA
Simple pain killers
NSAIDs
Which DMARD is used in JIA
Methotrexate
Which 3 biologics are used to treat JIA
Anti-TNF
IL-1 R antagonist (Anakinra)
IL-6 Antagonist (Tocilizumab)
Indications for systemic steroids in JIA
Systemic JIA
Serious disease complications with any of the subtypes
Children undergoing surgery
Bridge between DMARD drugs
Side effects of steroids
Osteoporosis
Infections
Growth abnormalities
DM
Describe oligoarticular JIA
55% of JIA
4 or less joint involvement
Ix for JIA
Examine Thorough history Rule out infection ESR ASO RF ANA
1st line rx for oligoarticular JIA
Simple pain killers
What is the main line Rx in oligoarticular JIA if 1 or 2 joints is affected
Local steroids
Criteria for Dx of JIA
<16 years >6 week history Joint swelling + 2 of following: Painful or limited joint motion Tenderness Joint swelling
What are the two classifications for polyarticular JIA
RF-ve
RF +ve
Are majority of polyarticular RF -ve or +ve
RF -ve
Ix for JIA
O/E History ESR CRP RF ANA
Rehabilitation for JIA options
Physio.
OT
Surgical Rx for JIA
Synovectomy
Reconstructive
Joint replacement
Symptoms of JIA
Young
Joint stiffness
Joint pain
Joint swelling
Which other organ is commonly affected in JIA apart from the joints
Eyes
Who does RF +ve polyarticular commonly affect
Girls
Older (12-16yrs)
Who does RF -ve polyarticular commonly affect
Young girls
Which eye condition is oligoarticular JIA commonly associated with
Uveitis
Which joints does oligoarticular JIA typically affect
Large joints
E.g knee, ankle, wrist, elbow
Which joints does polyarticular JIA typically affect
Typically symmetrical
Often involving small joints of the hand and feet
Describe psoriatic JIA
Usually presents with: Arthritis FH Psoriasis (1st degree) Nail changes, and/or dactylitis; psoriatic rash may/may not be present.
Who does enthesitis JIA typically affect
Boys 6
Describe enthesitis JIA
affects boys over the age of 6 years and usually presents with asymmetrical arthritis, enthesitis, and sacro-iliac joint involvement.
For which JIA would you tend to worry most about opthamological involvement
Oligoarticular
Which is the least common JIA
Systemic onset
Which is the most serious JIA
Systemic onset
Describe RF and ANA generally in systemic JIA
RF -ve
ANA -ve
Generally
Clinical features of Systemic JIA
Fever (characteristic)
Evanescent salmon pink macular rash
Lymphadenopathy
Joint involvement
Does joint involvement for systemic JIA need to be present for a diagnosis
No not initially
Describe the fever in systemic JIA
more of a high grade fever
Patterned fever
Can spike at the same time everyday or twice a day with spontaneous return to baseline
What is another name for systemic JIA
Stills Disease
What internal organ involvement can occur in systemic JIA
Hepatosplenomegaly Generalised lymphadenopahty Polyserositis Pericarditis Pleural effusion
When do joint manifestations of systemic JIA occur
Within 3-12 months of rash/fever symptoms
Which factor is enthesitis JIA commonly relied to
HLA-B27
What FH could suggest enthesitis JIA
Ankylosing spondylitis
What FH would suggest psoriatic JIA
FH of psoriasis
What is enthesitis
Pain where bone meets tendon
What is undifferentiated JIA
JIA presenting with features of more than one subtype
