Juvenile Iodiopathic Arthritis

Question 1

what is juvenile idiopathic arthritis?

Answer 1

systemic inflammatory disorders affecting children less than 16 years old

Question 2

what is the pathogenesis of juvenile idiopathic arthritis?

Answer 2

> autoimmune disease

> string subset of specific genetic markers affect the immune response

Question 3

what is the criteria for diagnosis of JIA?

Answer 3

> less than 16 years age of onset
> duration of disease more than 6 weeks
> presence of arthritis
 - joint swelling
 - 2 of: painful limited joint motion, warmth or tenderness

Question 4

describe the epidemiology of type 1 pauci-articular JIA

Answer 4

before 5 years and affecting girls more 9:1

Question 5

how does pauci-articular JIA present?

Answer 5

> limp
> mainly lower limb joints
> irregular iris
> asymptomatic
> chronic uveitis

Question 6

what percentage of type 1 Pauci-articular JIA is ANA positive?

Answer 6

40-75%

Question 7

what is the epidemiology of type 2 pauci-articular JIA?

Answer 7

after 8/9years and a ration of girls 1: boys 7

Question 8

hoe does type 2 pauci-articular JIA present?

Answer 8

> limp
lower limb joints
hip can be affected early and may evolve into spodyloarthritis

Question 9

what is the epidemiology of type 3 pauci-articular JIA?

Answer 9

> can occur any age during childhood girls4:boys1

Question 10

how does type 3 pauci-articular JIA present?

Answer 10

> dactylitis
asymmetric arthritis
family history of psoriasis (nail pitting)
chronic iridocyclitis

Question 11

what percentage of pauci-articular cases go onto extended oligoarthritis?

Answer 11

30%

Question 12

what is the epidemiology of RF negative poly-articular JIA?

Answer 12

> girls 9:1 boys

> any age

Question 13

what is the presentation of RF -ve poly-articular JIA?

Answer 13

> hepatosplenomegaly
> low grade fever
> symmetric joints (large and small)
> growth abnormalities
> mild anaemia

Question 14

what is the epidemiology of RF +ve poly-articular JIA?/

Answer 14

> late childhood

> girls 7: 1 boys

Question 15

what is the presentation of RF positive poly-articular JIA?

Answer 15

> anaemia
> fever
> nodules
> malaise
> weight loss

Question 16

what are some complications of RF positive polyarticular JIA?

Answer 16

> sjogrens
vasculitis
pulmonary fibrosis

Question 17

true or false

in RF positive poly-articular JIA erosions occur early in xrays?

Answer 17

true

Question 18

what is systemic polyarticular JIA?

Answer 18

extraarticular features define the disease. it starts early and disappears after 2-5 years

Question 19

what is the epidemiology of systemic poly-articular JIA?

Answer 19

can occur throughout childhood and girls 1.5 to 1 boys

Question 20

how does systemic polyarticular JIA present?

Answer 20

> fever
 - late evenings and afternoon
 - 39.5 degrees daily at least 2 weeks
> rash
 - thighs
 - trunk
 - salmon red eruption
 - brought on by scratching
> lymph nodes (generalised)
> abdo. pain
> hepatosplenomegaly
> transaminases
> serositis
> pericarditis
> pulmonary
 - fibrosis
 - effusion
> arthritis within 3-12 months of fever onset

Question 21

what is first line therapy in JIA?

Answer 21

> NSAIDs

Question 22

what is second line therapy in juvenile idiopathic arthritis?

Answer 22

> methotrexate
Anti-TNF
IL-1 R antagonist [anakinra]
IL-6 antagonist [tocilizumab]

Question 23

when are systemic steroids indicated?

Answer 23

> systemic JIA
serious disease complications
undergoing surgery
as a bridge between DMARDs

Question 24

what are the risks with systemic steroids?

Answer 24

> growth abnormalities
infections
osteoporosis

Question 25

what are local intraarticular steroids used for?

Answer 25

> oligoarticular JIA

> eye disease

Question 26

what surgeries can be used in JIA?

Answer 26

> synovectomy
reconstruction
replacement