Juvenile_Idiopathic_Arthritis_Pauciarticular_Flashcards

Question 1

What is juvenile idiopathic arthritis (JIA)?

Answer 1

JIA describes arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks.

Question 2

What is pauciarticular JIA?

Answer 2

Pauciarticular JIA refers to cases where 4 or fewer joints are affected. It accounts for around 60% of cases of JIA.

Question 3

What are the features of pauciarticular JIA?

Answer 3

Joint pain and swelling, usually in medium-sized joints (e.g., knees, ankles, elbows), limp.

Question 4

What is the significance of ANA positivity in JIA?

Answer 4

ANA may be positive in JIA and is associated with anterior uveitis.

Question 5

Who should manage patients with Juvenile Idiopathic Arthritis (JIA)?

Answer 5

Patients should be managed by a specialist paediatric rheumatology multidisciplinary team.

Question 6

What types of therapy are encouraged for JIA patients?

Answer 6

Physical and occupational therapy

Question 7

Why is inactivity discouraged in JIA patients?

Answer 7

Inactivity leads to deconditioning, disability, and decreased bone mass.

Question 8

What activities are JIA patients advised to participate in?

Answer 8

Activities such as swimming or cycling.

Question 9

What are the components of pharmacological management for JIA?

Answer 9

Simple analgesia (e.g., Paracetamol)
NSAIDs for controlling pain and stiffness
Weak opioids (e.g., codeine) if necessary

Question 10

When are corticosteroids used in JIA management?

Answer 10

Intra-articular, oral, or IV corticosteroids are used as adjunctive agents while waiting for second-line agents to take effect but are avoided if possible due to risks of growth suppression and osteoporosis.

Question 11

What are the first-line and second-line DMARDs used in JIA management?

Answer 11

1st line: oral or SC methotrexate
2nd line: sulfasalazine

Question 12

What other treatments might be used for JIA?

Answer 12

Inflammatory cytokine blockade (e.g., TNF-alpha inhibitors), interleukin receptor antagonists, anti-emetics.

Question 13

What is the prognosis for most children with JIA?

Answer 13

Most children can expect good disease control and quality of life.

Question 14

What are the potential complications of poor disease control in JIA?

Answer 14

Joint damage
Anterior uveitis
Osteoporosis
Growth failure

Question 15

summarise JIA

Answer 15

Juvenile idiopathic arthritis: pauciarticular

Juvenile idiopathic arthritis (JIA), now preferred to the older term juvenile chronic arthritis, describes arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks. Pauciarticular JIA refers to cases where 4 or less joints are affected. It accounts for around 60% of cases of JIA

Features of pauciarticular JIA
joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
limp
ANA may be positive in JIA - associated with anterior uveitis

Question 16

summarise JIA management

Answer 16

Juvenile Idiopathic Arthritis (JIA)
 Patients should be managed by a specialist paediatric rheumatology multidisciplinary team
 Physical and occupational therapy is encouraged
 Inactivity leads to deconditioning, disability and decreased bone mass so patients are advised
to participate in activities such as swimming or cycling
Management
 Pharmacological management:
o Simple analgesia e.g. Paracetamol
o NSAIDs are useful for controlling pain and stiffness o Consider weak opioids e.g. codeine
 Intra-articular, oral or IV corticosteroids are useful adjunctive agents (whilst waiting for second-line agents to have an effect) – avoided if possible due to risk of growth suppression and osteoporosis
 DMARDs - used when the disease fails to respond to conventional treatments
o 1st line: oral or SC methotrexate o 2nd line: sulfasalazine
 Other treatments: Inflammatory cytokine blockade e.g. TNF-alpha inhibitors, interleukin receptor antagonists, anti-emetics
Prognosis
 Most children can expect good disease control and quality of life
 Complications (with poor disease control):
o Joint damage o Anterior uveitis o Osteoporosis o Growth failure

Question 17

A 15-year-old girl presents to her GP with a 2-month history of bilateral knee pain, felt worst in the mornings. She has also been experiencing general fatigue but has had no fevers, weight loss, or rashes.

Her family history is notable only for her mother who has systemic lupus erythematosus (SLE).

On examination, her vital signs are normal. There is mild knee and ankle oedema bilaterally and tenderness on passive movement of the knee joints.

What is the most likely diagnosis?

Ewing sarcoma
Oligoarticular juvenile idiopathic arthritis
Osgood-Schlatter disease
Systemic lupus erythematosus (SLE)
Systemic-onset juvenile idiopathic arthritis

Answer 17

Oligoarticular juvenile idiopathic arthritis

Pauciarticular JIA is the most common presentation type and is typically mild

Oligoarticular (or pauciarticular) juvenile idiopathic arthritis (JIA) is the most common presentation of JIA and is defined as affecting up to four joints. Typically this involves larger joints such as the knee, ankle or elbows. Common symptoms include pain or stiffness in the affected joints and fatigue. Associated symptoms may include rash, fever, dry or gritty eyes. Family history for autoimmune disease (systemic lupus erythematosus in this case) is a risk factor for JIA.

Ewing sarcoma is a primary cancer of bone typically affecting long bones and presenting with localised pain and swelling. This would normally be unilateral, and highly unlikely to present symmetrically.

Osgood-Schlatter disease is an inflammation of the growth plate (apophysitis) at the tibial tubercle secondary to traction from the quadriceps. It typically occurs in the rapidly-growing adolescent who is involved in sports/athletics. It can involve both tibia, although the presentation is typically unilateral. Worse on exercise and not associated with knee effusions.

Systemic lupus erythematosus (SLE) is a chronic multi-system disorder that commonly includes arthritis or arthralgia. The absence of other systemic symptoms or rash suggests a primary arthritis in this case, despite the family history.

Systemic-onset juvenile idiopathic arthritis is a subset of JIA that requires the onset of joint symptoms accompanied by regular and intermittent fevers for diagnosis.