RHEUMATIC DISORDERS

Question 1

What do we call arthritis that occurs in someone under the age of 16?

Answer 1

Juvenile idiopathic arthritis

Question 2

What is the prevalence of juvenile idiopathic arthritis?

Answer 2

1 in 1000 children

Question 3

What are the main 3 types of juvenile idiopathic arthritis?

Answer 3

Systemic (previously called Still’s disease)

Polyarticular

Oligoarticular

Question 4

What age group is most commonly affected by systemic juvenile idiopathic arthritis?

Answer 4

Under 5 year olds

Question 5

Which joints are primarily affected in systemic juvenile idiopathic arthritis?

Answer 5

Both knees, wrists, ankles and tarsal bones.

Question 6

What are the clinical features of systemic juvenile idiopathic arthritis?

Answer 6

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

Question 7

What are the subdivisions of polyarticular juvenile idiopathic arthritis?

Answer 7

Rheumatoid factor negative

Rheumatoid factor positive

Question 8

How many joints must be affected for juvenile idiopathic arthritis to be classified as polyarticular rather than oligoarticular?

Answer 8

More than 4

Question 9

Is the arthritis in polyarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

Answer 9

Symmetrical

Question 10

What age group is most commonly affected by rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

Answer 10

All ages are affected

Question 11

Which joints are primary affected in rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

Answer 11

All joints can be affected.

There is particular limitation in the motion of the neck and temporomandibular joint.

Question 12

What age group is most commonly affected by rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Answer 12

Girls over the age of 8

Question 13

Which joints are primary affected in rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Answer 13

Arthritis of the small joints of hands and feet

Hip and knee joints affected early

Question 14

What are the extra-articular features of rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Answer 14

Rheumatoid nodules on pressure points

Systemic vasculitis

Question 15

How many joints are affected in oligoarticular juvenile idiopathic arthritis?

Answer 15

4 or less

Question 16

Which joints are primarily affected by oligoarticular juvenile idiopathic arthritis?

Answer 16

Knees

Ankles

Elbows

Hips tend to be spared

Question 17

What age group is most commonly affected by oligoarticular juvenile idiopathic arthritis?

Answer 17

Girls under 6 years old

Question 18

Is the arthritis in oligoarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

Answer 18

Asymmetrical

Question 19

What is typically found on an antibody screen of a child with oligoarticular juvenile idiopathic arthritis?

Answer 19

ANA

Question 20

What are the extra-articular features of oligoarticular juvenile idiopathic arthritis?

Answer 20

Iridocyclitis (inflammation of the iris and ciliary body)

Anterior uveitis

Question 21

What investigations should be done in a child that presents with signs and symptoms consistent with juvenile idiopathic arthritis?

Answer 21

FBC - anaemia occurs in systemic disease

Acute-phase reactants - raised

RF - negative in majority of cases

ANA - oligoarticular

X-ray

Question 22

How do we manage a child with juvenile idiopathic arthritis?

Answer 22

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