MSK: Juvenile Idiopathic Arthritis Flashcards

1
Q

It is the most common chronic joint disease in children and adolescence. True or false?

A

True

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2
Q

How is it defined?

A

Persistent joint swelling of > 6 weeks presenting before 16 in the absence of infection or any other defined cause

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3
Q

What is the prevalence in the UK?

A

1 in 1000

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4
Q

How many subtypes are there?

A

At least 7

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5
Q

How is it classified?

A

Clinical and based on number of joints affected in first 6 months

  • polyarthritis = more than 4 joints
  • oligoarthritis = up to and including 4
  • systemic = with rash and fever

Presence of rheumatoid factor and HLA B27 tissue type

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6
Q

What features are present?

A
Gelling - stiffness after periods of rest 
Morning joint stiffness
Painful joints 
Intermittent limp 
Deterioration in behaviour or mood
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7
Q

Is there joint swelling?

A

Initially may be minimal, but subsequently swelling due to fluid within joint, inflammation, chronic arthritis, thickening of synovium and swelling of periarticular soft tissue

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8
Q

Why can diagnosis be difficult initially?

A

Presentation can be indolent

Initially blood tests normal and x ray

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9
Q

What complications can occur?

A
Chronic anterior uveitis 
Flexion contractures at joints 
Growth failure 
Constitutional problems - anaemia of chronic disease, delayed puberty
Osteoporosis
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10
Q

Why can growth failure occur?

A

Generalised from anorexia, chronic disease and systemic corticosteroids
Localised overgrowth e.g leg length discrepancy due to prolonged knee synovitis

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11
Q

What is the overall management aim?

A

Induce remission

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12
Q

Medical management includes:

A

NSAIDS and analgaesia to relieve symptoms during flare
Joint injections (intra-articulate corticosteroids)
Methotrexate - used early reduces joint damage
Systemic corticosteroids- avoided if possible
Biologics - severe disease refractory to methotrexate

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