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Year 4 - Paediatrics > Rheumatology - Juvenile Idiopathic Arthritis > Flashcards

Rheumatology - Juvenile Idiopathic Arthritis Flashcards

1
Q

What is JIA?

A

Autoimmune inflammation of the joints causing arthritis in children and adolescents

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2
Q

How is JIA diagnosed?

A

Arthritis without any other cause lasting more than 6 weeks in under 16s

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3
Q

What are the key features of JIA?

A

Joint pain
Swelling
Stiffness

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4
Q

What are the 5 different subtypes of JIA?

A
  • Systemic JIA
  • Polyarticular JIA
  • Oligoarticular JIA
  • Enthesitis related arthritis
  • Juvenile psoriatic arthritis
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5
Q

How is systemic JIA also known?

A

Still’s disease

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6
Q

What are the typical features of systemic JIA?

A
  • Subtle salmon-pink rash
  • High swinging fevers
  • Enlarged lymph nodes
  • Weight loss
  • Joint inflammation and pain
  • Splenomegaly
  • Muscle pain
  • Pleuritis and pericarditis
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7
Q

What is raised in systemic JIA?

A

CRP
ESR
Platelets
Serum ferritin

Rheumatoid and ANA are negative

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8
Q

What is a key complication of systemic JIA?

A

Macrophage activation syndrome

Severe activation of the immune system with a large inflammatory response

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9
Q

How does macrophage activation syndrome present?

A

Presents with acutely unwell child with
- DIC
- Anaemia
- Thrombocytopenia
- Bleeding
- NBR

Life threatening

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10
Q

What investigation is key in macrophage activation syndrome?

A

Low ESR

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11
Q

What are the key non-infective differentials for high fevers in kids for over 5 days?

A

Kawasaki disease
Still’s disease
Rheumatic fever
Leukaemia

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12
Q

What is polyarticular JIA?

A

Idiopathic inflammatory arthritis in** 5 joints or more**

Symmetrical

Can affect small joints of hands and feet and large joints e.g. hips and knees

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13
Q

What symptoms are there in polyarticular JIA?

A
  • Joint pain
  • Joint swelling
  • Joint stiffness
  • Mild fever
  • Anaemia
  • Reduced growth
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14
Q

What is the difference between seronegative and seropositive in polyarthritis?

A

Seronegative - rheumatoid factor negative

Seropositive - rheumatoid factor positive

Polyarthritis is equivalent to rheumatoid arthritis in adults

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15
Q

What is oligoarticular JIA?

A

4 joints or less

Usually only affects a single joint - monoarthritis

Tends to affect larger joints e.g. knee or ankle

Occurs more in girls under 6

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16
Q

What classic feature is associated with oligoarticular JIA?

A

Anterior uveitis

Oligo = Ophthalm

17
Q

What symptoms are there in oligoarticular JIA?

A

No systemic symptoms

Just joint issues

18
Q

What is elevated in OJIA?

A

Inflammatory markers are normal or slightly elevated

ANA are often positive
Rheumatoid are negative

19
Q

What is Enthesitis-Related Arthritis?

A

Common in boys over 6

Paediatric version of seronegative spondyloarthropathy conditions

Inflammatory arthritis in joints + enthesitis

20
Q

What is enthesitis?

A

Inflammation at the point tendon inserts into a bone

21
Q

What can cause enthesitis?

A

Traumatic stress by repetitive strain in sports or autoimmune inflammation

22
Q

How can enthesitis be detected?

A

MRI scan

Unable to differentiate between stress or autoimmune

23
Q

What do majority of patients with enthesitis-related arthritis have?

A

HLAB27 gene

24
Q

What should you look for when assessing a patient with enthesitis-related arthritis?

A
  • Psoriasis signs
  • IBD signs
  • Anterior uveitis
25
Q

What should you do when examining a patient with enthesitis-related arthritis?

A

Patients will be tender to palpation of the entheses

Palpate
- IPJs
- Wrist
- Over greater trochanter on lateral hip
- Quadriceps insertion at the ASIS
- Quadriceps and patellar tendon at the patella
- Base of the Achilles
- Metatarsal heads on base of the foot

26
Q

What is juvenile psoriatic arthritis?

A

Seronegative inflammatory arthritis associated with psoriasis

Can have symmetrical polyarthritis affecting small joints or asymmetrical arthritis affecting large joints

27
Q

What signs on examination are associated with juvenile psoriatic arthritis?

A
  • Plaques of psoriasis
  • Nail pitting
  • Onycholysis (separation of nail from the bed)
  • Dactylitis (full finger inflammation)
  • Enthesitis
28
Q

How is JIA managed?

A

Paediatric rheumatology with a specialist MDT

Reduce inflammation in joints and minimise symptoms

  • NSAIDs
  • Steroids, either oral, IM or intra-articular in oligoarthritis
  • DMARDs
  • Biologic therapy e.g. TNFis, infliximab

Year 4 - Paediatrics (150 decks)

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