Juvenile Idiopathic Arthritis Flashcards
Aetiology of JIA?
Autoimmune
- Unknown but strong genetic link
Age range?
<16 years
General symptoms?
Fatigue Malaise Arthritis Disability - Blindness - Refusal to walk Pleural issues
TENOSYNOVITIS
DDx?
Acute septic arthritis (MUST BE RULED OUT)
Osteomyelitis
Gender difference?
Mostly > girls
What are the 2 broad subtypes?
Pauciarticular < or equal to 4 joints affected
>4 joints affected
What is found in type 1 pauciarticular?
ANA +ve in most cases
What age range is type 1 pauciarticular?
1-3 years
What joints are typically affected in type 1?
Any but RARELY HIP
What telltale symptom may be present in type 1?
Chronic uveitis
What can chronic uveitis lead to?
Blindness
What is the name given to type 2 pauciarticular JIA?
Enthesitis related
What gene may be affected in type 2 pauciarticular JIA?
HLA-B27
Who is most likely affected in type 2 pauciarticular JIA?
Boys
7-8 yrs
Why is it called enthesitis related?
Can cause enthesitis of the achilles tendon
What is type 3 pauciarticular JIA related to?
Psoriasitic arthritis
- Usually also has a +ve FH of psoriasis
- Patient may develop symptoms particularly nail pitting
What hand signs can be seen in type 3 PA JIA?
Dactylitis
What joints are affected in type 3 PA JIA?
Asymmetrical upper limb
What are the 2 types of >4 joints affected JIA?
RF +ve
RF -ve
What symptom may be present in RF -ve that shouldn’t be present in any others?
Symmetrical
Low fecer
What is RF +ve JIA pretty much?
Rheumatoid arthritis <16
What is STILLs disease?
Any number of joints with JIA with systemic disease
- Spiking fever (very high)
- Shock symptoms
Rash
Generalised lymphadenopathy
HSM
Serositis
What is the type of rash in STILLs disease?
Salmon pink eruption
What can be caused by serositis?
Pericarditis
Rarely pleurisy
What must be ruled out in JIA?
Sepsis!!!!!”!!”!£!”£!”$!£%FDFGwgWEGR`
Tests?
Bloods
- ESR raised
- FBC
- RF
- ANA
- ASO
USS
Why is an FBC done?
Rule out malignancy
What is ASO?
Anti-streptolysin
Can be raised in JIA without evidence of recent strep infection
1st line treatment in polyarthritis?
NSAIDs
2nd line treatment in mono-JIA?
I.A. Steroid injections
2nd line typical treatment?
DMARDs
Who MUST all children be referred to with JIA?
Opticians
What are the anti-TNF drugs that can be used in DMARD therapy?
Infliximab
Etanercept