Juvenile Idiopathic Disease, Told, Part I

Question 1

synonyms for juvenile arthritis

Answer 1

juvenile RA
juvenile chronic arthritis
juvenile idiopathic arthritis

Question 2

Dx juvenile arthritis

Answer 2

by exclusion

Question 3

demographics juvenile arthritis

Answer 3

< 9 years old

Question 4

Criteria for Dx JIA

Answer 4

6 weeks
poly, pauci or systemic
exclusion of other forms juvenile arhtritis

Question 5

ddx JIA

Answer 5

SLE, reactive, lymes, dermatomyositis, kawasaki
rheumatic fever, IBD, hematologic, vasculitis, septic arthritis, toxic synovitis hip
neoplasia
infantile onset multi systemic
psychogenic

Question 6

Systemic onset of HIA

Answer 6

1+ joints

extra articular features 6+ weeks

Question 7

pauciarticular JIA

Answer 7

subtype I: classic
II: spondylitic
III: psoriatic

Question 8

nail and skin manifestation JIA

Answer 8

subtype III pauciarticular

Question 9

Polyarticular JIA

Answer 9

RF+ or -

Question 10

determinant of prognosis in polyarticular JIA

Answer 10

RF - is better prognosis

Question 11

spondylitic JIA

Answer 11

enthesitis related

II pauciarticular

Question 12

growing pains

Answer 12

6-13 y.o
thighs, calves, shins
late in day or night

Question 13

Tx growing pains

Answer 13

heat massage and analgesics

Question 14

Stills disease

Answer 14

systemic JIA

Question 15

What are signs and Sx stills disease

Answer 15

malaise, rash, fever, adenopathy, HSM, serositis, hepatits, DIC, anemia

Question 16

MSK Sx of stills

Answer 16

arthritis, myalgia, arthralgias

Question 17

age of onset

Answer 17

< 5 F=M (most common)

>5 F>M

Question 18

fever curve in systemic JIA

Answer 18

all over the place

Question 19

rash in juvenile rheumatoid arthritis

Answer 19

transient
salmon pink
circumscibed macular
2-6 mm or bigger, confluent
chest, axilla thighs and upper arms

Question 20

does the rash in JRA itch

Answer 20

not usually

Question 21

Labs for systemic JIA

Answer 21

ESR- high
CBC- anemia, leukocytosis and thrombocytosis
IgM RF -
ANA -

Question 22

age of onset compared to pronosis for systemic JIA

Answer 22

younger age of onset – worse prognosis

Question 23

what can occur in child with persistent JIA

Answer 23

amyloidosis

Question 24

management of systemic JIA

Answer 24

splinting to prevent deformity
PT and OT
NSAID
corticosteroids
DMARDs

Question 25

MTX in child

Answer 25

can affect growth

Question 26

most common JIA subtype

Answer 26

pauciarticular subtype I

Question 27

clinical features subtype I pauciarticular JIA

Answer 27

ankle>elbow>hip) early growth abnormalities chronic uveitis within 5 years

Question 28

chornic uveitis in pauciarticular disease

Answer 28

subtype I

Question 29

labs for subtype I pauciarticular JIA

Answer 29

ESR increased or wnl CBC wnl RF - ANA + 40-75%

Question 30

HLA assoc with subtype I pauciarticular JIA

Answer 30

HLA A2, DR5 DRw6 DRw8

Question 31

prognosis of subtype I pauciarticular JIA

Answer 31

early detection is key | long term good

Question 32

altered growth in subtype I pauciarticular JIA

Answer 32

iridocyclitis both eyes

Question 33

management pauciarticular disease subtype I

Answer 33

``` splinting PT OT NSAIDs local steroid injections frequent ophthalmologic assessment ```

Question 34

juvenile spondlyoarthropathy

Answer 34

pauciarticular disease subtype II

Question 35

age of pauciarticular disease subtype II

Answer 35

>9 | M>F

Question 36

clinical features pauciarticular disease subtype II

Answer 36

``` peripheral arthritis in LE enthesopathies acute iritis SI pain axial disease ```

Question 37

presenting signs in pauciarticular disease subtype II

Answer 37

SI pain | axial disease

Question 38

labs in pauciarticular disease subtype II

Answer 38

ESR wnl to high CBC wnl RF - HLA B27+!!!!

Question 39

course prognosis pauciarticular disease subtype II

Answer 39

good, some joint extension | 1/3 develop spondylitis hip and cervical problems

Question 40

management pauciarticular disease subtype II

Answer 40

``` PT and OT posture training NSAIDs anti TNF agents local corticosteroid injections hip arthroplasty ophthalmologic exam and follow up ```

Question 41

general characteristics pauciarticular JIA subtype III psoriatic

Answer 41

~8 years F>M FMH psoriasis rarely systemic

Question 42

clinical features pauciarticular JIA subtype III psoriatic

Answer 42

``` occasional severe destructive arthritis dactylitis asymmetric peripheral joint psoriatic rash, nail pitting, onycholysis flexor tenosynovitis ```

Question 43

what is dactylitis

Answer 43

swollen joint

Question 44

labs in pauciarticular JIA subtype III psoriatic

Answer 44

ESR varies, can be high CBC Hb/Hct low, WBC inc RF negative ANA positive

Question 45

course and prognosis pauciarticular JIA subtype III psoriatic

Answer 45

young onset assoc with iritis remitting and relapsing, even into adulthood occasionally severely destructive occasionally spondylitis develops

Question 46

management pauciarticular JIA subtype III psoriatic

Answer 46

``` PT and OT splinting NSAIDs may need immunosuppression (MTX) biologic agents (anti TNG, IL-1ra) ```

Question 47

gen characteristics polyarticular JRA

Answer 47

> 5joints | 30% JRA patients

Question 48

RF - polyarticular JIA

Answer 48

``` M any joint reduced neck and TMJ ROM flexor tenosynovitis mild lymphadenopathy and HSM, low grade fever ```

Question 49

Labs in RF - polyarticular JIA

Answer 49

ESR inc CBC anemia, leukocytosis, thrombocytosis RF - ANA sometimes +

Question 50

course and prognosis polyarticular JIA

Answer 50

variable, may be monocyclic but prolonged with good outcome | recurrent episodes tend to cause progressive deformities

Question 51

management polyarticular RF - JIA

Answer 51

``` splinting to prevent deformity PT OT maintain and improve joint and muscle function NSAIDs DMARDs anti TNF agents ```