Juvenile Idiopathic Arthritis Flashcards

1
Q

Whats makes an arthritis JIA?

A

Systemic Inflammatory disorders

Has to be <16yrs old

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2
Q

What is required for us to diagnose JIA?

A
Onset <16yrs
Duration >6wks
Symptoms:
Joint Swelling OR 2 of:
- Tenderness
- Painful/limited ROM
- Warmth
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3
Q

There are 3 major subtypes of JIA (only determinable after 6 months)?

A
Pauciarticular (55%) - <5 joints
Polyarticular (25%) - >4 joints
Systemic Onset (20%) - Still's Disease
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4
Q

There are 3 subtypes of Pauciarticular JIA (Type 1, 2 & 3). Here’s some characteristics of each:

A

1) 1-3yrs so tend to present with unusual gait rather than complaining of pain. Chronic uveitis is 90% of females <2.
2) Can feature hip/back pain which can rarely progress to ankylosing spondylitis. Only pauci more common in boys!!
3) Ass with psoriasis & Dactylitis

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5
Q

What are the subtypes of Polyarticular JIA?

A

RF -ve (15%)

RF +ve (10%

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6
Q

What sets polyarticular apart from pauciarticular (other than more joints)?

A

Potential Systemic Symptoms:

  • Low grade fever
  • Malaise & weight loss
  • Hepato-splenomegaly
  • Mild Anaemia
  • Growth abnormalities
  • Nodules

Can be complicated by vasculitis, Sjogren’s or pulm fibrosis

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7
Q

Whats special about how Still’s Disease (Systemic onset JIA) presents?

A

Systemic features start first with arthritis not occuring till 3-12 months in.

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8
Q

Who gets Still’s Disease?

A

1.5F:1M, mostly 4-6yrs old

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9
Q

How does Still’s Disease Start?

A

Fever.
It rises daily in the afternoon/evening for at least 2 weeks.
Look for a child toxic with fever that goes away in the morning

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10
Q

50-75% of Still’s Patients get Abdominal symptoms such as…

A

Hepatosplenomegaly
Abdo Pain
Raised Transaminases

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11
Q

How many stills patients get lymph symptoms?

A

50-75% geet non-tender Generalised Lymphadenopathy

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12
Q

90% of Still’s Patients present with a rash, descirbe it?

A

Evanescent Salmon Red Eruption on their trunk/thighs along with the fever.
It can be brought on by scratching (aka Koebner’s Phenomenon)

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13
Q

Very rarely Still’s Patients can get pulmonary symptoms like..

A

Pleural effusion

Pulm. Fibrosis

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14
Q

Inflammation of Serous membranes can come with Still’s Disease, what types are common?

A

36% of patient’s get Polyserositis including pericarditis

Rarely they can get tamponade and myocarditis

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15
Q

How do the actual arthritis symptoms appear in Still’s Disease?

A

Start 3-12months after the fever onsets

Wrist, ankle, knee, C-spine, hips & TMJ

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16
Q

What tests can we do to diagnose and determine the subtype of JIA?

A

1) ANA (commonest in pauciarticular) & RF (subtype of polyarticular)
2) ESR/CRP (Most elevated in systemic onset)
3) FBC (May see anaemia, thrombocytosis & leucocytosis. Esp in polyarticular and Systemic onset)
4) Opthalmology screening for uveitis (mostly in pauciarticular)

17
Q

1st Line treatment of JIA?

A
SImple Pain Killers
NSAIDs
Local Steroids:
- IA in Pauciarticular JIA
- For Eye disease
18
Q

What if NSAIDs & Steroids fail?

A

Methotrexate

19
Q

What if NSAIDs, steroids and MTX fail?

A

Anti-TNF drugs

20
Q

How do we treat Refractory Systemic Arthritis?

A

IL-1 Receptor Antagonist - Anakinra

IL-6 Antagonist (Tocilizumab)

21
Q

When would we risk using systemic steroids?

A

Systemic JIA
Serious compliated JIA e.g. pericardial effusion, tamponade, vasculitis, severe anaemia or severe eye disease
Bridge between DMARDs
Surgery

22
Q

What are the risks of systemic steroids?

A

Osteoporosis
Infection
Growth Abnormality

23
Q

So summarise the likely presentations of Systemic Onset JIA?

A
1st = Daily rising and falling fever
2nd:
- Generalised Lymphadenoapthy
- Evanescent Salmon red rash
- ~ serositis
- ~ Abdo pain, hepatosplenomegaly & raised transaminases

Then 3-12months later the arthritis starts

24
Q

What does iridocyclitis indicate?

A

Unlikely to be polyarticular

25
Q

When are topical steroids used in JIA?

A

REHABILITATION:

  • Physiotherapy
  • Occupational therapy
26
Q

What surgery may be carried out in JIA?

A

Synovectomy – removal of inflamed synovial tissue

Reconstructive/joint replacement surgery