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Fall 2020 Exam 2 > Juvenile Idiopathic Arthritis > Flashcards

Juvenile Idiopathic Arthritis Flashcards

1
Q

JIA formerly known as

A

juvenile rheumatiod arthritis

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2
Q

definition of JIA

A

arthritis of unknown etiology

lasting 6 weeks or more

occuring in kids before their 16th birthday

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3
Q

How many categories are there?

A

6 - depending on location and number of joints and presence or lack of inflamatory markers

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4
Q

1 Oligoarthritis

A

affects 1-4 joints during the first 6 months

can be persistant (1-4) or

extended (4+) after the first 6 months

earlier onset - usually around 4 years old

common in females

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5
Q

2 Polyarticular

A

affects 5 or more joints during the first 6 months

broken down in to RF negative or positive

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6
Q

RF negative Polyarticular

A

No rheumatoid factor present when tested

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7
Q

RF positive Polyarticular - when to repeat testing?

Which gender is more affected?

Age of onset?

A

Two positive tests- three months apart in first 6 months

more aggresive disease course

higher risk of joint deformities d/t errosive joints/RA

Common in females

onset 1-3 years and

around 12 years old

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8
Q

3 Enthesitis related arthritis

A

ERA presents with arthritis and enthesitis (infl of ligaments/tendons where they connect to the bone)

common in BOYS

usually has spine and sacroiliac joint involvement and back pain

can present with an acute painful red eye

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9
Q

4 systemic

A

intermittant fever, rash, arthritis, systemially ill with myalgia/arthralgia

This triad of fever/rash/arthritis doesnt have to appear at the same time

fever/rash may occur before arthritis pain

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10
Q

5 psoriatic arthritis

A

psoriasis and arthritis present

may have dactylsis (swelling of fingers)

onycholysis (nail pitting)

+ fam h/o psoriasis in first degree relative

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11
Q

6 undifferentiated arthritis

A

kids that meet criteria for 2+ types

OR

dont meet criteria for any type

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12
Q

JIA genetic causes

A

heterogenous disorder, enviornmentally induced in genetically predispositioned person

25-40% in monozygotic twins

siblings with 15-30 fold higher prevalence of dev JIA

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13
Q

Autoimmune & genetic cause of JIA

humoral and cell medicated immunity concerns

A

ILRA/CD25 and VTCN1 genes known for succeptability in kids

HLA-I and II leads to the dev of T cells and antigen presentation

activation of the humoral immune resp is seen in the prod of antinuclear antibodies (ANA) and serum IGGs such as IgM rheumatiod factor

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14
Q

enviornmental RF

A

maternal smoking

infection/trauma may initiate autoimmune reaction - T cells and pro-inflammatory cytokines

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15
Q

Bone health recomendations for prevention

A

Vit D, sun exposure, breastfeeding

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16
Q

Which gender is affected more?

A

females > males but depends on type

onset equal in both sets

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17
Q

Type more common in african americans?

A

polyarticular and RF+

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18
Q

Type more common in white children/european discent

A

Oligoarthritis

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19
Q

early referral

A

important for early aggressive treatment

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20
Q

onset in late teen years

A

related to progression to adult rheumatoid diesase

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21
Q

Disease progression

A

many never have another episode or may be in remission for months then reoccur

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22
Q

Indications for poor prognosis

A

systemic onset, positive RF factor, poor resp to therapy, bone erosion

< 4 joints - arthritis of hip or cervical spine

> 5 joints - arthritis of hip or cervical spine and RF +

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23
Q

Joint problems

A

osteopenia/osteoporosis, bony erosions, premature fusion of growth plates, sublaxated/unstable joints, epiphyseal overgrowth, eventual fusion/ankylosis

TMJ - bilateral can disrupt growth of mandible results in micrognathia and retrognathia

arthritis- limited mobility, decreased QOL, joint damage, psyc issues

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24
Q

What is enthesitis ?

A

infl of sites where ligaments or tendons insert into bone

knee, achilles tendon, greater trochanter, planter fascia insertion on feet or metatarsal heads

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25
Q

Uveitis

A

infl of the eyes - should be checked by optho dependig on type of JIA (ANA positive OJIA)

can result in cataracts, glaucoma, blindness if untreated

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26
Q

eye exam frequency for ANA positive OJIA and PJIA

onset < 7 years old

A

Q 3-4 months

ANA - antinuclear antibodies r/t autoimmune pathophys and humoral immune resp

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27
Q

eye exam frequency for ANA positive OJIA and PJIA

7 + years old

A

Q 6 months

28
Q

eye exam frequency for ANA negative OJIA and PJIA

all ages

A

Q 6 months

29
Q

antinuclear antibodies

A

related to autoimmune pathophysiology and humoral immune response

30
Q

Macrophage Activation Syndrome and JIA (MAS)

A

Life threatning complication

persistant fever, cytopenias, fixed rash, elevated D-dimers and liver enzymes, low fibrinogen, decreased ESR rates, and elevated coagulopathy and triglycerides

31
Q

Gelling and morning stiffness

A

gelling - joint stiffness after prolonged inactivity

stiffness - improves as the day goes on

32
Q

Presentation in toddlers

A

may present with a lip, grumpy upon wakening,

* pain is not a primary symptom

arthritis and synovitis can be painless

33
Q

JIA history clues

A

growth

gelling

morning stiffness/achiness

limping

swelling/warmth

34
Q

JIA presenting s/s

A

Decreased ROM - observe activity, positions, gait, walking and running

Joint effustion/tenderness

leg legnth discrepancy - abnormal gait

malnutrition

jaw pain

35
Q

Long term presentation

A

bony overgrowth - usually over knees

muscle weakness/atrophy

leg legnth discrepancy - affected leg will be longer due to overgrowth

micro or retrognathia (TMJ) - difficulty chewing or opening mouth

36
Q

diagnosis

A

usually made clinically as all labs may be normal there is no definitive lab test

37
Q

Olgoarthritis and labs

A

usually have negative lab markers

38
Q

polyarthritis and labs

A

usually have elevated acute phase reactants and

anemia of chronic disease

39
Q

Labs

A

CBC- exclude leukemia dx, check for anemia, bone pain closely resimbles malignancy

ESR/CRP- deteft infl and infection

Lyme titers- to r/o lyme

LFT- r/o hepatitis and check liver function

rheumatoid factor- identifies subtype

40
Q

immunoflurescent test

A

gold standard for ANA test

positive ANA (anti-nuclear antibody) helps determine if the child is at risk for uveitis and determine if there is an auto-antibody problem

41
Q

anti-ccp antibodies

A

check for, seen with more aggressive types of disease and may show before onset of s/s

42
Q

Imaging

A

Xray- used initially to r/o traumatic/ortho issues

MRI- can be used to determine extent of joint involvement or dificult areas to see on x-ray

US- helpful to use in younger kids who wont sit still for imaging, less invasive

Immaging is unable to differentiate between underlying causes of arthritis, like malignancy, infl, infection

43
Q

4 main goals of treatment

A
  1. suppress inflammation
  2. preserve/maximize joint function
  3. prevent joint deformities
  4. prevent blindness
44
Q

NSAID use in JIA

A

use in those with low-disease activity with less than 4 joints, without poor prognosis or joint contracture

2 week trial warranted

lack of response to one NSAID does not confer response to all agents in the class- trial alternatve NSAID should be considered

45
Q

Ibuprofen use, dosing and s/e

A

30-40 mg/kg/day in 3-4 divided doses

Max dose 2400mg/day

S/E abd pain, peptic ulcer disease, gastritis, thrombocytopenia, renal toxicity w long-term use

46
Q

Naproxen use, dosing and s/e

A

10mg/kg/day in 2 divided doses

max dose 1000mg/day

For more moderate pain NSAIDs should be used in adjunct.

Labs before starting and twice yearly for daily use lasting > 3-4 weeks

CBC, LFT, serum creatine

47
Q

Celexocib (Celebrex)

A

can be used if the patient has severe GI s/e from NSAIDS

NO ASPRIN- RYES

Topical OTC pain patches- OTC salonpas has 4% lidocaine

48
Q

Non-biological DMARD

disease modifying antirheumatic drug =

Methotrexate

A

Prescribed by rheumatologist

s/e: GI- abd pain, nausea, hematologic, lover toxicity, oral ulcers

49
Q

Systemic glucocorticoids

A

no longer recomended d/t adverse se and availability newer theraputic regimens

50
Q

growth

A

may have slow growth esp from meds like steriods and inflammation

51
Q

Diet

A

foods to lower inflammation

52
Q

fiber rich foods

A

quinoa, sweet potatoes, beans

53
Q

clean protein

A

salmon, grass fed beef

54
Q

fruits/veg

A

folate rich, dark leafy greens, beets, berries, tomatoes, cherries, broc,

55
Q

herbs/spices

A

ginger, rosemary, cinnamon

56
Q

omega 3 rich

A

salmon, tuna, sardines

57
Q

Calcium/Vit D

A

immune boosting and strong bone development

58
Q

Diet foods to avoid

A

sugar, sat/trans fat, artificial ingredients, charred foods, all increase inflammation

59
Q

safety risk

A

joint damage/risk of injury from sports

driving with uveitis

60
Q

avoid live vaccines if

A

taking immunosuppressive drugs

should get PCV 13, prevnar and Flu

61
Q

screening

A

TMJ, pericarditis, LFT, serum creat, NSAID monitoring, routine hearing

62
Q

eye exam frequency

A

Q 3-4 months or Q6 months

dep on ANA status or type

63
Q

puberty

A

may be late onset

Methotrexate - tetrogenic NSAIDS avoid if pregnant

64
Q

resources

A

Kids health

american arthritis foundation

65
Q

prognosis

A

onset in teen years may progress into adult life

wanes and completely subsides in 85% of patients

66
Q

low impact sports to recommend

A

swimming (not for those with anemia or cardiac hx)- easy on joints,

Dance- low impact

tricycle or bike riding

yoga

Fall 2020 Exam 2 (7 decks)

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