Rheumatology Flashcards
What is the most common chronic rheumatological disease in children?
Juvenile idiopathic arthritis
What is the incidence of JIA?
2-23 per 100,000
Why does JIA occur?
- Not completely understood
- Genetic susceptibility
- Immune response
- Release of pro-inflammatory markers including TNF, interleukin 1+2
- Presence of antibodies
How do children with JIA present?
- 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 is the differential diagnosis for JIA?
- Septic arthritis
- Osteomyelitis
- Transient synovitis
- Malignancies i.e lymphoma, neuroblastoma, bone tumours
- Recurrent haemarthrosis
- Vascular abnormalities
- Trauma
- Others
What are the signs of JIA?
- Swelling: periarticular soft tissue oedema, intraarticular effusion, hypertrophy of synovial membrane
- Tenosynovitis (swollen tendons)
- Joint held in position of maximum comfort
- Range of motion limited at extremes
What classification system is used for JIA?
ILAR classification
What types of JIA are there?
- Polyarticular
- Oligoarthritic/Pauciarticular
- Psoriatic
- Enthesitis-Related
- Systemic
What is oligoarthritic/pauciarticular JIA?
- 4 or fewer joints
- Large joints and asymmetrical
What are the 2 types of oligoarhr JIA?
- Early childhood onset (more common)
- Late childhood onset
Who does early childhood onset oligoarthritic JIA usually affect?
Girls aged 1-5
Who does late childhood onset oligoarthritic JIA usually affect?
Boys over 8
What are the features of late childhood onset oligoarthritic JIA?
- Test negative for ANA
- No extra-articular manifestation
- Hip involvement
What are the features of early onset oligoarthritic JIA?
- 20-30% develop uveitis
- Test positive for ANA
- Joints commonly affected include: knees, ankles, hands, feet and wrists
- No hip involvement
What is polyarticular JIA?
- 5 or more joints affected
- Few or no systemic manifestations of disease
What are the 2 types of polyarticular JIA?
- Seronegative (20-25%)
- Seropositive (5-10%)
Who is usually affected by seronegative polyarticular JIA?
Girls under 5
Who is usually affected by seropositive polyarticular JIA?
Girls over 8
What are the features of polyarticular JIA?
- Tempomandibular joint injury is common leading to limited bite and micrognathia
- Systemic manifestations are rare but can include fever, slight hepatomegaly, lymphadenopathy, pericarditis and chronic uveitis
- Onset can be acute but mostly insidious
- Large fast growing joints are mostly affected
What is enthesitis-related JIA?
Inflammation of the enthesis along with arthritis
What is the criteria fro enthsitis-related JIA?
2 or more
- Onset of oligoarthritis/polyarthritis in a boy >8 years
- HLA B27 positive
- Acute anterior uveitis
- Inflammatory spinal pain
- Sacroiliac joint tenderness
- FMH
What is psoriatic JIA?
Chronic arthritis and definite psoriasis is evident
What is always positive in psoriatic JIA?
HLA B27
What is the criteria fro psoriatic JIA?
2 or more:
- FMH
- Dactylitis: finger or toe swelling
- Onycholysis: nail pitting
