Juvenile idiopathic arthritis Flashcards
What is Juvenile idiopathic arthritis?
Group of systemic inflammatory disorders affecting children below age of 16 years.
The most commonly diagnosed Rheumatic disease in children.
An important cause of disability and blindness.
What causes JIA?
A combination of genetic, environmental and immunological factors (multi-factorial)
What is the criteria for diagnosis?
Age of onset - less than 16yrs
Duration of disease - >6 weeks
Presence of arthritis - joint swelling or 2 of the following: painful or limited joint motion, tenderness or warmth
What are the 3 main clinical subtypes of JIA?
Pauciarticular, - most common - involves 4 or less joints
Polyarticular - 5 or more joints involved
Systemic onset - affects much of the body
Pauciarticular JIA
Common in girls
Iritis common
Chronic uveitis in 20% of cases - inflammation of uvea in the eye (iris, ciliary, body and choroid)
Mainly affects lower limb joints (knee, ankle etc)
Lots of children with this condition will outgrow it by adulthood. Still, eye problems can continue, and joint symptoms may come back.
Polyarticular JIA
Can present with constitutional manifestations (low grade fever, malaise, weight loss)
Anemia or Nodules.
Presents in late childhood and more common in girls
Which is the least common subtype of JIA?
Systemic
It has the most serious short and long term morbidity and mortality though
Systemic JIA
Presents throughout childhood
Signs of this include joint swelling, fever, and a light pink rash. It may involve the heart, liver, spleen, and lymph nodes.
A small percentage of children who have it develop arthritis in their joints. They may have severe arthritis that lasts into adulthood.
1st line therapy for JIA
Simple pain killers
NSAIDs
2nd line therapy for JIA
If no response to NSAIDs/ joint (steroid) injections…
1 - Methotrexate
2 - Anti-TNF
3 - IL-1 R-antagonist
4 - IL-6 antagonist
When might systemic steroids be used to treat JIA?
In systemic JIA
Serious disease complications with any subtype
Children undergoing surgery
Local steroid treatment
Intra-articular mainly in Oligo-articular JIA
Eye disease (ANA +ve oligo-articular disease).
Non medical treatment for JIA
Physio
Occupational therapy
Surgical treatment options for JIA
Synovectomy - remove inflammed synovial tissue
Reconstructive / joint replacement surgery
