Rheumatology Flashcards
what is the presentation of JIA?
joint swelling for at least 6 weeks morning stiffness / gelling rash fever fatigue poor appetite weight loss irritability or refusal to walk in toddlers school absence or limited ability to participate in physical activity delayed puberty, growth restriction
what are differential diagnoses JIA?
septic arthritis osteomyelitis transient synovitis recurrent haemarthoses vascular abnormalities trauma malignancies i.e. lymphoma, bone tumour
what are differentiating features of septic arthritis and JIA?
JIA affects > 1 joint septic arthritis only 1 joint septic arthritis joint is swollen hot and red JIA isn't red or hot JIA hx for weeks septic arthritis acute hx
what are the features of systemic JIA?
arthritis intermittent fever > 2 weeks salmon pink erythematous rash generalised lymphadenopathy sensitise hepatosplenomegaly high ESR (normal CRP)
what are the treatments for JIA?
intra-articular steroids
DMARD’s i.e. methotrexate
biologics i.e. Anti TNF alpha
what type of JIA has poor response to intra articular steroids?
oligoarticular JIA
what are the complications of uveitis?
glaucoma
cataracts
blindness
what are the symptoms of uveitis?
really symptomatic
redness
headache
reduced vision
what is the treatment for uveitis in JIA?
topical steroids (systemic if more severe)
DMARD and biologics if poor response
what are some of the signs on clinical examination of a child with JIA?
periarticular soft tissue oedema intra-articular effusion tenosynovitis pain joint held in position of maximum conforrt range of movement limited at extremities
what features are required for a diagnosis of psoriatic JIA?
chronic arthritis and definite psoriasis + 2 of the following;
dactylics
nail pitting or onycholysis
psoriasis in 1st degree relative
HLA B27 positive
what features are required for a diagnosis of enthesitis-related JIA?
at least 2 of the following;
onset of poly arthritis/oligoarthritis in a boy > 8 yrs
sacroiliac joint tenderness
inflammatory spinal pain
acute anterior uveitis
HLA B27 positivity
family history in 1st degree relative
in what age of onset and gender is oligoarticular JIA most common?
early childhood onset most common in girls 1-5yrs
if late onset most common in boys > 8 yrs
what’s the difference in the distribution of oligoarticular JIA depending on early and late onset?
early onset affects hands, knees, ankles and feet
late onset hip involvement
will children with early onset JIA test positive for ANA?
yes - late onset are negative
