Juvenile Idiopathic Arthritis Flashcards
What is idiopathic juvenile arthritis?
A group of systemic inflammatory conditions that affect children below the age of 16 years. An auto injure disease that has many different causes than adult RA.
An important cause of disability and blindness.
What are the criteria for diagnosis of Juvenile idiopathic osteoarthritis
Age of onset under 16
Lasts for over 6 weeks
Joint swelling or 2 of the following:
Limited or painful joint movement
Tenderness
Warmth
What are the three major subtypes of the disease that can be identified after 6 moths?
Pauciarticular
Polyarticular
Systemic onset
What is type I pauciarticular juvenile idiopathic athritis?
Peak age 1-3 years, typically before 5 years More common in girls Presents as limp in lower leg joints Knee/ankle most common, Chronic uveitis in 20% of cases
Describe type II pauciarticular juvenile idiopathic arthritis
Typically presents at age 8-9, more common in boys
Limp due to LL affection
Mainly knee and ankle
Hips, sacroiliac joints may be affected and can lead to AS or spondyloarthritis
Describe type 3 pauciarticular arthritis
Can affect any age, more common in girls Asymmetric upper and lower limb arthritis Dacylitis (digit arthritis) Can be very destructive Family history of psoriasis
Describe RF-ve polyarticular arthritis
Age age, mostly girls
Presents with low grade fever, malaise, mild anemia, growth abnormalities and hepato-splenomegaly
Describe RF positive polyarticular arthritis
Late childhood, teens (12-16 years)
Girls more likely
Presents with low grade fever, malaise, weight loss, anemia, nodules,
Early x-ray erosions, similar to adult RA but in children
May have sjorgens or vasculitis, pulmonary fibrosis
What is systemic onset juvenile arthritis
Mainly 4-6 years, occurs to both sexes equally
High fever that rises daily for at least 2 weeks, returns to normal by evening
Toxic fever and chills in morning but looks normal when fever goes away
90% have a evanescence salmon red eruption on trunk and things
Accompanies fever, can be brought by scratching
Lymphadenopathy, hepato-splenomegalt and abdominal pain all common
Arthritis in wrists, knees, ankles, cervical spine, hips and TMJ
What is very common in patients with idiopathic juvenile arthritis
Eye diseases:
Uveitis- especially in those within the oligio group, related to ANA positivity
Cataracts and eye surgery
Risk of blindness associated with the condition
Important to screen for regularly
How do you treat uveitis in juvenile arthritis
Steroids Mydriatic and cycloplegic agents Methotrexate MMF Ciclosporin Anti-TNF
What is 1st therapy for juvenile arthritis?
NSAIDS can control disease
What is 2nd therapy for juvenile arthritis?
If no response to NSAIDs then joint/steroid injections
Rarely needed in oligoarticular JIA
Methrotrexgae
Anti TNF
IL-1 R antagonist or Anakinra (refractory systemic athritis)
IL-6 antagonist or Tocilizumab for refractory system disease
When are systemic steroids used?
What are the side effects?
Limited indications due to serious side effects Only used:
Systemic JIA (control pain and fever), serious disease complications e.g. Periocoridal effusion, tamponade, vasculitis, severe autoimmune anemia, severe eye disease
As a bridge between DMARDS
Children undergoing surgery
Risk of osteoporosis, infections, growth abnormalities.
What local steroids can be used
Intra-articulations mainly in oligo-articulations JIA Eye disease (ANA +ve oligo articulations disease)
