Juvenile Idiopathic Arthritis

Question 1

What is the epidemiology of juvenile idiopathic arthritis?

Answer 1

1 in 1000 children below 16

Most common diagnoses rheumatic disease in children

Question 2

What are the clinical manifestations of and types of JIA?

Answer 2

Diagnosis criteria: <16yo, >6 weeks disease, arthritis or 2 of - painful or limited joint motion, tenderness, warmth

3 major subtypes: pauci(oligo)articular, polyarticular, systemic onset

Pauci= 4 or less joints, mainly LL joints, constitutional upset is rare, girls more than boys. Type 2 may have dactylitis.
Poly = 5 or more joints, RF-ve: symmetric large and small joints, may have constitutional symptoms, hepatosplenomegaly, anaemia. RF+ve: same symptoms but with nodules.
Systemic = extra articular features: swinging pyrexia, rash, lymphadenopathy, hepatosplenomegaly, abdo pain, polyserositis, arthritis

Question 3

How is JIA managed and treated?

Answer 3

1st line = analgesia, NSAIDs, steroid injections (I-A mainly oligo articular, and eye disease)
2nd line = no response to 1st line, begin: methotrexate, anti TNF, IL-1 R-antagonist, IL-6 anatagonist

Systemic steroids used in systemic JIA, serious disease complications however limited use due to serious side effects
Other TM includes rehabilitation with physiotherapy and occupational therapy
Surgery is synovectomy or redonstructive/joint replacement

Question 4

What is the natural progression and complications of JIA?

Answer 4

Oligo>poly>systemic

Complications:

• uveitis which can lead to potential blindness, posterior synechiae, cataracts, band keratopathy
• growth failure: localised or generalised