Juvenile Idiopathic Arthritis Flashcards
What is juvenile Idiopathic arthritis?
Group of systemic inflammatory disorders affecting children below the age of 16
Criteria for diagnosis of juvenile idiopathic arthritis?
Age of onset - <16 years
Duration of disease- >6 weeks
Presence of arthritis
What criteria would indicate the presence of arthritis?
Joint swelling or 2 of the following:
Painful or limited joint motion,
Tenderness,
Warmth
After 6 months what are the 3 subtypes of JIA identified?
Pauciarticular,
Polyarticular,
Systemic onset
What is pauciarticular JIA?
JIA of 4 or less joints
Age of onset of pauciarticular JIA type 1
Peak 1-3 years,
More common in females
Presentation of pauciarticular JIA type 1?
Limp, Mainly lower limb joints, Chronic uveitis (can lead to blindness), Irregular iris ANA +ve
Age of onset of pauciarticular JIA type 2?
After 8-9,
More common in boys
Presentation of pauciarticular JIA type 2
Limp, Mainly lower limbs, Acute iridocyclitis Hip can be affected, ? Enthesitis, ? AS or spondyloarthritis,
Age onset and gender of pauciarticular JIA type 3?
Any childhood age,
Girls more common than boys
Presentation of pauciarticular JIA type 3?
Asymmetrical UL and LL arthritis, Dactylitis, FH of psoriasis, ? Nail pitting, Chronic iridocyclitis
What gender is more liokely to get polyarticular JIA RF -ve?
Female
Presentation of polyarticular JIA RF -ve
Constitutional manifestations, Hepato-splenomegaly, Mild anaemia, Growth abnormalities, Arthritis of symmetric large and small joints
What is polyarticular JIA?
Arthritis of 5 or more joints
Age onset and gender of polyarticular JIA RF +Ve?
Late childhood,
Girls more common
Presentation of polyarticular JIA RF +ve?
Constitutional manifestations,
Anaemia,
Nodules,
Erosions in Xray
Extra-articular symptoms that define systemic onset JIA?
Fever, Rash, Lymphadenopathy, Heptosplenomegaly, Abdominal pain, Serositis, Arthritis,
Fever presentation of systemic onset JIA
Rises to 39.5C daily for at least 2 week,
Late afternoon/ evening worse,
Normal/subnormal in morning,
Fever +/- chills
Rash presentation of systemic onset JIA
Evanescent salmon red eruption,
Trunk and thighs,
Fever,
+ve Koebner’s phenomenon (brought on my scratching)
Lymph node presentation of systemic onset JIA
Generalised lymphadenopathy,
Non-tender
Abdominal presentation of systemic onset JIA
Hepatosplenomegaly,
Abdominal pain,
+/- transaminases
Serositis presentation of systemic onset JIA
Polyserositis,
Pericarditis,
Tamponade,
Myocarditis
Pulmonary presentation of systemic onset JIA
Pleural effusion,
Pulmonary fibrosis
Arthritis presentation of systemic onset JIA
Within 3-12 months of onset of fever,
Wrists, knees, ankles, cervical spine, hips and TMJ
Complications of uveitis
Posterior synechiae,
Cataract,
Band keratopathy
Treatment of uveitis?
Steroids, Mydriatic and cycloplegic agents, Methotrexate, Cyclosporin, Anti-TNF
1st line therapy of JIA?
NSAIDs,
2nd line therapy for JIA?
Methotrexate,
Anti-TNF Rex,
IL-1 R-antagonist (anakinra)
IL-6 antagonist (toclilzumab)
When are systemic steroids used in JIA?
Systemic JIA,
Serious disease complications,
Bridge between DMARDs,
Undergoing surgery
Risk of using systemic steroids?
Osteoporosis,
Infections,
Growth abnormalities
Surgical treatment of JIA?
Synovectomy,
Reconstructive/ joint replacement surgery
Growth failures that can occur in JIA?
Leg length discrepancies, Micrognathia, Shortening of fingers, hands, forearms, toes, feet, Short stature, Delayed puberty
