Idiopathic Juvenile Arthritis Flashcards
Define idiopathic arthritis
Objective arthritis (swelling in one or more joints) for at least 6 weeks manifesting <16 years old in the absence of infection or other defined cause
Define arthritis, oligoarthritis, polyarthritis and still’s disease
Arthritis: swelling or effusion, increased warmth, and/or painful limited movements with or without tenderness
Oligoarthritis/Pauciarticular: 4 or less joints are effected (60% JIA cases)
Polyarthritis: >4 joints affected
Systemic: Still’s disease - fever and rash
What are the risk factors for juvenile idiopathic arthritis
Female sex
Leukocyte antigen polymorphisms
FHx autoimmunity
What are the symptoms of juvenile idiopathic arthritis
Joint pain: >6 weeks, worse on motion and palpation
Joint swelling: commonly at the knees
Morning stiffness - may present as reluctance to have a nappy change in the morning
Gelling (stiffness after rest)
Limp
Rash: non-pruritic, non-fixed, erythematous
Fever
What are the symptoms and signs of systemic/late juvenile idiopathic arthritis
pyrexia
salmon-pink rash
Genu valgum/knock knees - Inflammation ± bone expansion (overgrowth with leg lengthening/valgus in systemic onset)
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
What are the signs of juvenile idiopathic arthritis on examination
Limp
Joint pain
Reduced range of motion
Joint swelling
Limb length discrepancy
Rheumatoid nodules (extensor surface of tendons)
Swan-neck deformity and hand problems
Systemic: genu valgum, salmon pink rash
What investigations should be done for juvenile idiopathic arthritis
Bedside: Endocervical/first catch/urethral swab for NAAT (rule out reactive arthritis)
Bloods: FBC, ESR/CRP, ANA (+), rheumatoid factor, anti-CCP
Other: US affected joints
What is the management for juvenile idiopathic arthritis
Specialist paediatric rheumatology MDT
- OT and PT (inactivity leads to deconditioning, disability and decreased bone mass)
- NSAIDs
- Corticosteroids (intra-articular, high dose for remission → switch to low dose for maintenance)
- DMARDs (1 = oral/SC methotrexate, 2 = sulfasalazine)
- Biologics e.g. TNF-a inhibitors, interleukin receptor antagonists
What are the complications of juvenile idiopathic arthritis
Anterior uveitis (chronic → cataracts and glaucoma)
Fractures
Growth failure
Flexion contracture of joints → joint destruction
Constitutional problems .g. anaemia of chronic disease, delayed puberty
Osteoporosis
Amyloidosis
Bone expansion → leg lengthening, valgus deformity
What is the prognosis for juvenile idiopathic arthritis
Most children can expect good disease control and quality of life
Poor disease control → significant morbidity from joint damage and visual impairment leading to anterior uveitis and fractures from osteoporosis