Rheumatology/JIA Flashcards
How might JIA present?
Arthritis for at least 6wks Morning stiffness Irritability/refusal to walk (toddlers) School absence/limited ability for physical activity Rash/fever Fatigue Poor appetite/wgt loss Delayed puberty
What are differentials for JIA?
Septic arthritis Osteomyelitis Transient synovitis Malignancy Recurrent haemarthrosis Vascular abnormalities Trauma
What are particular signs of JIA?
Swelling Tenosynovitis Pain Joint held in pos. max comfort Range of motion limited at extremes
What is the classification system for JIA?
ILAR classification
What age are females most likely to present with JIA?
1-5yrs
What age are males most likely to present with JIA?
> 8yrs
What are the 3 patterns of onset of JIA?
- Oligoarthritic/pauciarticular: (4 or fewer joints)
- Polyarticular (Occasionally 9 joints)
- Systemic (Large joints, no symmetry)
What is common in children with late onset?
- Test negative for ANA
- No extra articular manifestation
- Hip involvement
What is common in children with early onset?
- Uveitis
- Test positive for ANA
- Joints: knees, ankles, hands, feet, wrists
- No hip involvement
When is it polyarticular JIA?
- 5+ joints
2. Few or no systemic manifestations of disease
Enthesitis-related JA should have two of what six red flags?
Onset of polyarthritis/oligoarthritis in boy >8 years of age HLA B27 positivity Acute anterior uveitis Inflammatory spinal pain Sacroiliac joint tenderness FHx of enthesitis-related JIA
Psoriatic JIA should have any two of which three red flags?
Dactylitis: finger or toe inflammation
Onycholysis: nail pitting
FHx psoriasis
What are the signs/symptoms of systemic JIA?
Unwell Arthritis Intermittent fever >2wks Salmon pink erythematous rash Generalised lymphadenopathy Serositis Hepatomegaly/splenomegaly High inflammatory markers
Which age group is seronegative (RF negative) more common in?
<5
Which age group is seronegative (RF negative) more common in?
<5yrs
What are the screening questions in the pGALS MSK screen?
Do you (or your child) have any pain or stiffness in their joints, muscles or back? Do you (or your child) have any difficulty getting themselves dressed without any help? Do you (or your child) have any problem going up and down stairs?
What investigations would you do for JIA?
Labs
Plain XR
US
MRI with contrast
What is the medical treatment for JIA?
NSAIDs
DMARDs
Biologic agents
Intra-articular and oral steroids
What are the treatment options for JIA?
Pharmacological management Counselling School/life adjustments Nutrition (anaemia and osteoporosis) Physical therapy OT
How long after intra articular steroids is remission usually?
> 6mo
What type of JIA are intra-articular steroids most effective?
Oligoarticular JIA
What is the DMARD of choice in JIA?
Methotrexate
When should biological agents be used in JIA?
Failure to respond to DMARDs
What are common biological agents used in JIA?
Anti-TNF agents
What is a common condition associated with JIA?
Uveitis
What can untreated uveitis lead to?
Chronic uveitis
What JIA is uveitis more common in?
ANA positive oligo JIA
What are symptoms of uveitis?
Red eyes
Headache
Reduced vision
What are complications of uveitis?
Cataracts
Glaucoma
Blindness
What is the treatment for uveitis?
Topical steroids
Systemic steroids
DMARDs and biological (if poor response to steroids)s
What are complications of JIA?
Poor growth Localised growth disturbances Micrognathia Contractures Ocular complications
What is micrognathia?
Lower jaw undersized
