RHEUMATIC DISORDERS Flashcards
What do we call arthritis that occurs in someone under the age of 16?
Juvenile idiopathic arthritis
What is the prevalence of juvenile idiopathic arthritis?
1 in 1000 children
What are the main 3 types of juvenile idiopathic arthritis?
Systemic (previously called Still’s disease)
Polyarticular
Oligoarticular
What age group is most commonly affected by systemic juvenile idiopathic arthritis?
Under 5 year olds
Which joints are primarily affected in systemic juvenile idiopathic arthritis?
Both knees, wrists, ankles and tarsal bones.
What are the clinical features of systemic juvenile idiopathic arthritis?
Pain in several joints including both knees, wrists, ankles and tarsal bones
High daily spiking fever
Salmon-pink rash
Lymphadenopathy
Hepatosplenomegaly
Malaise and myalgia
Inflammation of pleura and serosal membranes
What are the subdivisions of polyarticular juvenile idiopathic arthritis?
Rheumatoid factor negative
Rheumatoid factor positive
How many joints must be affected for juvenile idiopathic arthritis to be classified as polyarticular rather than oligoarticular?
More than 4
Is the arthritis in polyarticular juvenile idiopathic arthritis symmetrical or asymmetrical?
Symmetrical
What age group is most commonly affected by rheumatoid factor negative polyarticular juvenile idiopathic arthritis?
All ages are affected
Which joints are primary affected in rheumatoid factor negative polyarticular juvenile idiopathic arthritis?
All joints can be affected.
There is particular limitation in the motion of the neck and temporomandibular joint.
What age group is most commonly affected by rheumatoid factor positive polyarticular juvenile idiopathic arthritis?
Girls over the age of 8
Which joints are primary affected in rheumatoid factor positive polyarticular juvenile idiopathic arthritis?
Arthritis of the small joints of hands and feet
Hip and knee joints affected early
What are the extra-articular features of rheumatoid factor positive polyarticular juvenile idiopathic arthritis?
Rheumatoid nodules on pressure points
Systemic vasculitis
How many joints are affected in oligoarticular juvenile idiopathic arthritis?
4 or less
Which joints are primarily affected by oligoarticular juvenile idiopathic arthritis?
Knees
Ankles
Elbows
Hips tend to be spared
What age group is most commonly affected by oligoarticular juvenile idiopathic arthritis?
Girls under 6 years old
Is the arthritis in oligoarticular juvenile idiopathic arthritis symmetrical or asymmetrical?
Asymmetrical
What is typically found on an antibody screen of a child with oligoarticular juvenile idiopathic arthritis?
ANA
What are the extra-articular features of oligoarticular juvenile idiopathic arthritis?
Iridocyclitis (inflammation of the iris and ciliary body)
Anterior uveitis
What investigations should be done in a child that presents with signs and symptoms consistent with juvenile idiopathic arthritis?
FBC - anaemia occurs in systemic disease
Acute-phase reactants - raised
RF - negative in majority of cases
ANA - oligoarticular
X-ray
How do we manage a child with juvenile idiopathic arthritis?
MDT approach
Physiotherapy - optimize joint mobility, prevent deformity and increase muscle strength
Medication:
Oligo: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor.
Poly: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor and then further escalated using another TNF-alpha inhibitor
Systemic: Systemic steroids with escalation to interleukin-1 receptor antagonists
