Rheumatology Flashcards
What is Juvenile Idiopathic Arthritis?
Inflammation of one or more of your joints that occurs before you turn 16.
What are the key features of JIA?
Arthritis for at least 6 weeks Morning stiffness or gelling Irritability of refusal to walk in toddlers School absence or limited ability to participate in physical activity. Rash/fever Fatigue Poor appetite/weight loss Delayed puberty
What are the signs of JIA?
Swelling in periarticular soft tissue oedema Intraarticular effusion Hypertrophy of synovial membrane Swollen tendons Pain Joint held in position of max comfort Limited ROM at extremes
How does Oligoarthritic JIA present?
Early onset more common
Girls 1-5
4 or less joints with no symmetry.
If early onset then 20-30% develop uvititis and test positive for ANA.
If late onset then test negative for ANA and no extrarticular manifestation.
How does pauciarticular JIA present?
Late onset more common Boys over 8yrs 4 or fewer joints, no symmetry. Knees, ankles and hands No hip involvement Hip involved in late stage
How does Polyarticular JIA present?
5 or more joints
Few or no systemic manifestations of disease
Seropositive more common in >8yrs.
Seronegative more common in <5yrs.
large fats growing joints mostly affected
Systemic manifestations rare.
Mostly insidious onset.
What classifies enthesitis-related JIA?
Need at least 2 of following: Onset of poly arthritis/oligoarthritis in boy > 8. HLA-B27 positive Acute anterior uveitis Family Hx of enthesitis related JIA Sacroiliac joint tenderness Inflammatory spinal pain.
What classifies Psoriatic JIA?
All are HLA-B27 positive Need 2 of following 3: Dactylitis Family hx of psoriasis Onycholysis (nail pitting)
What are some systemic features of JIA?
Intermittent fever > 2weeks Salmon pink erythematous rash Generalised lymphadenopathy Serositis Hepato/splenomegaly High inflammatory markers
What are some investigations for JIA?
Examination Plain x-ray US MRI with contrast Labs -HLA-B27, inflammatory markers etc.
What are some treatment options for JIA?
- Intra-articular Steroids
- Disease Modifiying Anti-Inflammatory drugs (DMARDs) e.g. methotrexate.
- Biologics e.g. Anti-TNF agents
What are some consequences of uveitis associated with JIA?
Red eyes Headache Reduced vision Cataracts Glaucoma Blindness Chronic uveitis
What is the treatment for uveitis?
Topical steroids
Systemic steroids if severe
DMARD and biologics if poor response
What are some complications of JIA?
Poor growth Localised growth disturbances Micrognathia - undersized lower jaw. Contractures - permanent tightening of tissues. Occular complications
