Paediatric Rheumatology Flashcards
what is the most common chronic rheumatologic disease in children?
JIA
what is JIA?
Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in kids and teens. It typically causes joint pain and inflammation in the hands, knees, ankles, elbows and/or wrists. But, it may affect other body parts too
what features and effects are seen in JIA?
Arthritis for at least 6 weeks
Morning stiffness or gelling
irritability or refusal to walk in toddlers
School absence or limited ability to participate in physical activity
Rash /fever
Fatigue
Poor appetite/wt loss
Delayed puberty
what are the differential diagnosis of JIA?
Septic arthritis
Osteomyelitis
Transient synovitis
Malignancies i.e lymphoma, neuroblastoma, bone tumours
Recurrent haemarthrosis
Vascular abnormalities
Trauma
others
what are the signs seen in JIA?
Swelling: periarticular soft tissue edema/intraarticular effusion/hypertrophy of synovial membrane
Tenosynovitis (swollen tendons)
pain
Joint held in position of maximum comfort
range of motion limited at extremes
what is Oligoarticular Juvenile Arthritis? and who does it occur in?
Affects four or fewer joints, typically the large ones (knees, ankles, elbows). Most common subtype of JIA.
what is the pattern of onset in children with oligoarticular juvenile arthritis?
The antibodies that target “normal” proteins within the nucleus of a cell are called antinuclear antibodies (ANA). Most of us have autoantibodies, but typically in small amounts. The presence of large amount of autoantibodies or ANAs can indicate an autoimmune disease. ANAs could signal the body to begin attacking itself which can lead to autoimmune diseases. A positive ANA can also be seen in juvenile arthritis.
what is polyarticular juvenile arthritis?
Affects five or more joints, often on both sides of the body (both knees, both wrists, etc.). May affect large and small joints. Affects about 25% of children with JIA.
what are the features and symptoms of polyarticular JA
enthesitis related JIA should have at least 2/6 signs which are what?
Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone
Also known as spondyloarthritis. Affects where the muscles, ligaments or tendons attach to the bone (entheses). Commonly affects the hips, knees and feet, but may also affect the fingers, elbows, pelvis, chest, digestive tract (Crohn’s disease or ulcerative colitis) and lower back (ankylosing spondylitis). More common in boys; typically appears in children between the ages of eight and 15.
what features are seen in psoriatic JIA?
Joint symptoms and a scaly rash behind the ears and/or on the eyelids, elbows, knees, belly button and scalp. Skin symptoms may occur before or after joint symptoms appear. May affect one or more joints, often the wrists, knees, ankles, fingers or toes
what is Systemic JIA?
Affects the entire body (joints, skin and internal organs). Symptoms may include a high spiking fever (103°F or higher) that lasts at least two weeks and rash. Affects about 10% of children with JIA
Accounts for 5-15% of JIA
what symptoms and signs are seen in systemic JIA?
Unwell
Arthritis
Intermittent fever>2 weeks
Salmon pink erythematous rash
Generalized lymphadenopathy
Serositis
Hepatomegaly/splenomegaly
High inflammatory markers
how do you diagnose JIA?
History
Physical examination findings
Investigation
no specific test for JIA, but your doctor will take blood tests and x-rays. They may also do other tests, including:
ultrasound or MRI scans to try to see if there’s arthritis and to rule out other conditions
removing fluid from a joint (aspiration) to rule out joint infection
bone marrow examination to rule out some rare conditions, especially if they think you have systemic-onset JIA
to be diagnosed with JIA, what is someone required to have?
you’ve had arthritis for six weeks or more
your symptoms started before your 16th birthday
your doctor has ruled out other conditions that can cause arthritis