Juvenille Arthritis Flashcards
Definition of Juvenile Idiopathic Arthritis
A group of systemic inflammatory disorders affecting children below the age of 16 years.
Prevelance of Juvenile Idiopathic Arthritis
16/100,000
Aetiology of Juvenile Idiopathic Arthritis
Multifactorial, combination of genetic, environmental and immunological factors.
Criteria of diagnosis for Juvenile Idiopathic Arthritis
<16 years
Duration of more than 16 weeks
Presence of arthritis (joint swelling or two of painful or limited joint motion, tenderness, warmth)
3 major subtypes of Juvenile Idiopathic Arthritis
Pauciarticular (55%)
Polyarticular (25%)
Systemic Onset (20%)
Other subtypes of JIA
Enthesopathy related arthritis
Juvenile Psoriatic Arthritis (oligo or spndylo with psoriasis)
Pauciarticular JIA
Affects 4 or less joints. There are three subtypes (type 1, 2,3)
Type 1 Pauciarticular JIA
Most common of this sub-type Age of onset before the age of 5 Occurs in girls Presentation - limp, usually occurs in the lower limbs. \+ANA
Complications - chronic uveitis (20% of cases), irregular iris due to posterior synechiae
Type 2 Pauciarticular JIA
Occurs in boys aged 8-9. Tends to present with a limp in the lower limbs. The hip can also be affected early with rapid damage requiring treatment with enthesitis. There may be involvement of the sacroiliac joints and may evolve spondyloarthritis.
Type 3 Pauciarticular JIA
Occurs in girls (4:1) during any age of childhood. The presentation is usually asymmetric upper limb and lower limb arthritis, dactylitis. Family history of psoriasis in 40% of patients. They may well develop psoriasis later on in life.
Polyarticular JIA
5> joints
Rheumatoid Factor negative Polyarticular JIA
This constitutes around 15% of JIA. Can occur at any age but often occurs early. It occurs more in females. It presents with low grade fever, malaise, hepato-splenomegaly, mild anaemia, growth abnromalities, symmetric large and small joints are affected. Affects distal interphalangeal joints.
Rheumatoid Factor +ve Polyarticular JIA
10% of JIA. It tends to occur during late childhood and it is more likely to occur in females. Presents with constitutional manifestations, anaemia, nodules, similar to RA but in children.
Systemic Onset JIA
This is the least common condition and tends to occur in 20% of cases. It is the most serious condition in terms of short and long term morbidity and mortality.
Stills Disease
Tends to occur in males. Presents with red salmon eruptions on the trunk and thighs, fever, pain of the wrists, knees, ankles, cervical spine, hips and TMJ. There can be hepatosplenomegaly, abdominal pain, increased transaminases, generalised lymphadenopathy.
