Juvenile Idiopathic Arthritis

Question 1

What is juvenile Idiopathic arthritis?

Answer 1

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

Question 2

Criteria for diagnosis of juvenile idiopathic arthritis?

Answer 2

Age of onset - <16 years
Duration of disease- >6 weeks
Presence of arthritis

Question 3

What criteria would indicate the presence of arthritis?

Answer 3

Joint swelling or 2 of the following:
Painful or limited joint motion,
Tenderness,
Warmth

Question 4

After 6 months what are the 3 subtypes of JIA identified?

Answer 4

Pauciarticular,
Polyarticular,
Systemic onset

Question 5

What is pauciarticular JIA?

Answer 5

JIA of 4 or less joints

Question 6

Age of onset of pauciarticular JIA type 1

Answer 6

Peak 1-3 years,

More common in females

Question 7

Presentation of pauciarticular JIA type 1?

Answer 7

Limp, 
Mainly lower limb joints,
Chronic uveitis (can lead to blindness),
Irregular iris 
ANA +ve

Question 8

Age of onset of pauciarticular JIA type 2?

Answer 8

After 8-9,

More common in boys

Question 9

Presentation of pauciarticular JIA type 2

Answer 9

Limp,
Mainly lower limbs, 
Acute iridocyclitis 
Hip can be affected,
? Enthesitis,
? AS or spondyloarthritis,

Question 10

Age onset and gender of pauciarticular JIA type 3?

Answer 10

Any childhood age,

Girls more common than boys

Question 11

Presentation of pauciarticular JIA type 3?

Answer 11

Asymmetrical UL and LL arthritis, 
Dactylitis,
FH of psoriasis,
? Nail pitting,
Chronic iridocyclitis

Question 12

What gender is more liokely to get polyarticular JIA RF -ve?

Answer 12

Female

Question 13

Presentation of polyarticular JIA RF -ve

Answer 13

Constitutional manifestations, 
Hepato-splenomegaly, 
Mild anaemia, 
Growth abnormalities,
Arthritis of symmetric large and small joints

Question 14

What is polyarticular JIA?

Answer 14

Arthritis of 5 or more joints

Question 15

Age onset and gender of polyarticular JIA RF +Ve?

Answer 15

Late childhood,

Girls more common

Question 16

Presentation of polyarticular JIA RF +ve?

Answer 16

Constitutional manifestations,
Anaemia,
Nodules,
Erosions in Xray

Question 17

Extra-articular symptoms that define systemic onset JIA?

Answer 17

Fever, 
Rash,
Lymphadenopathy,
Heptosplenomegaly, 
Abdominal pain,
Serositis,
Arthritis,

Question 18

Fever presentation of systemic onset JIA

Answer 18

Rises to 39.5C daily for at least 2 week,
Late afternoon/ evening worse,
Normal/subnormal in morning,
Fever +/- chills

Question 19

Rash presentation of systemic onset JIA

Answer 19

Evanescent salmon red eruption,
Trunk and thighs,
Fever,
+ve Koebner’s phenomenon (brought on my scratching)

Question 20

Lymph node presentation of systemic onset JIA

Answer 20

Generalised lymphadenopathy,

Non-tender

Question 21

Abdominal presentation of systemic onset JIA

Answer 21

Hepatosplenomegaly,
Abdominal pain,
+/- transaminases

Question 22

Serositis presentation of systemic onset JIA

Answer 22

Polyserositis,
Pericarditis,
Tamponade,
Myocarditis

Question 23

Pulmonary presentation of systemic onset JIA

Answer 23

Pleural effusion,

Pulmonary fibrosis

Question 24

Arthritis presentation of systemic onset JIA

Answer 24

Within 3-12 months of onset of fever,

Wrists, knees, ankles, cervical spine, hips and TMJ

Question 25

Complications of uveitis

Answer 25

Posterior synechiae,
Cataract,
Band keratopathy

Question 26

Treatment of uveitis?

Answer 26

Steroids,
Mydriatic and cycloplegic agents, 
Methotrexate, 
Cyclosporin, 
Anti-TNF

Question 27

1st line therapy of JIA?

Answer 27

NSAIDs,

Question 28

2nd line therapy for JIA?

Answer 28

Methotrexate,
Anti-TNF Rex,
IL-1 R-antagonist (anakinra)
IL-6 antagonist (toclilzumab)

Question 29

When are systemic steroids used in JIA?

Answer 29

Systemic JIA,
Serious disease complications,
Bridge between DMARDs,
Undergoing surgery

Question 30

Risk of using systemic steroids?

Answer 30

Osteoporosis,
Infections,
Growth abnormalities

Question 31

Surgical treatment of JIA?

Answer 31

Synovectomy,

Reconstructive/ joint replacement surgery

Question 32

Growth failures that can occur in JIA?

Answer 32

Leg length discrepancies, 
Micrognathia,
Shortening of fingers, hands, forearms, toes, feet, 
Short stature, 
Delayed puberty