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MSK II - Exam 2 > JIA-LM > Flashcards

JIA-LM Flashcards

1
Q

what is JIA also know as/previously

A

Synonyms:

  • Juvenile Rheumatoid Arthritis (JRA) = USA
  • Juvenile Chronic Arthritis (JCA)= Europe
  • Juvenile Idiopathic Arthritis (JIA)= International League of Rheumatology
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2
Q

tHERE IS NO single best what for JIA

A

a) Characteristic Appearance
b) Diagnostic Criterion
c) Treatment
d) Uniform prognosis

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3
Q

SO pauci has less than 5 hot joints but how many are in the subdivisions of mono and oligo?

A

mono=1

oligo=2-4

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4
Q

extended pauci has how many hot joints

A

5-6

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5
Q

what about poly arthritis?

A

6+

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6
Q

what is a hot joint?

A

•Any swelling or effusion, increased warmth, and/or painful limited movement with or without tenderness in one or more joints lasting more than 6 weeks.

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7
Q

What is the age demographic of JIA

A

<9 y/o

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8
Q

What is the ACR Classification Criteria for the Diagnosis of JIA.

Lets break it down

AGE

How many joints involved

Duration

TYpe of onset of disease during the first 6 months

Exclusion of what

A
  1. Age at onset < 17 years
  2. Arthritis in 1 or more joints
  3. Duration of disease > 6 weeks
  4. Type of onset of disease during the first 6 mos
  • Polyarthritis
  • Pauciarthritis
  • Systemic Disease

5.Exclusion of other forms of juvenile arthritis

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9
Q

What are the 3 main types of JIA

What are the % occurances of each?

A

Systemic 10-15

Pauciarticuar (oligoarticular) 50%+

Polyarticular 30-40%

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10
Q

What are some characteristics of growing pains

Yeah I know, so let me give you categories to guess from, ya dummies.

Age

Distribution of pain

Time of Day for pain

Exercise induced?

DO they grow ok?

How do you treat?

A
  • Age: 6-13 yrs of age
  • Distribution: Lower extremities

–Pain localized to thighs, calves & shins (not joints)

  • Pain most frequent late in day or night (not morning)
  • Correlation with strenuous exertion is variable
  • Normal growth & development
  • Treatment: heat, massage & analgesics
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11
Q

So lets talk about systemic JIA also known as what……………………. Still’s disease

What are some signs and symptoms that are systemic?

A

–Malaise, fever, rash, adenopathy, hepatosplenomegaly, serositis, hepatitis, DIC, anemia

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12
Q

MSK sym of Still’s

A

–Arthritis, myalgia, arthralgias

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13
Q

AOO for still’s?

thats age of onset for all you slow people

there is a thing about sex and age so try to get that too.

A

–Usually < 5 yoa

  • If < 5 yoa F=M
  • If > 5yoa F>M
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14
Q

Describe the fever in Systemic JIA.

A

Spiking, crazy all over the place up and down what the heck.

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15
Q

What is this?

A

fusiform or spindle form fingers from systemic JIA

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16
Q

Describe the rash in systemic JIA? Note that pruritis is unsual

color

shape

size

distribution

A
  • Evanescent (transient) and intermittent
  • Salmon pink
  • Circumscribed macular
  • Size: 2-6 mm or greater, Often confluent
  • Chest
  • Axilla
  • thighs & upper arms
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17
Q

What will the ESR be in Systemic JIA?

CBC would show what?

A

Dr Told said all your inflammatory markers should be up.

  • ESR - high
  • CBC

–Anemia

–Leukocytosis (inc. polys

–Thrombocytosis

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18
Q

What is the IgM RF and ANA in systemic JIA?

A
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19
Q

What confers a worse prognosis on Systemic JIA?

If the disease persist what could happen

A

youger the age of onset.

Amyloidosis in some children

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20
Q

So you have this kid with Still’s how do you manage the disease?

A

Splinting

PT/OT

NSAIDS

Steroids in what cases? Severe, right on Steve

DMARDS with questional benefit.

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21
Q

What age and sex are common in pauci articular JIA

A

<6

F>M

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22
Q

What are some clinical features of pauci?

How many and which joints

how do they grow?

etc

A
  • Joints:
  • Early growth abnormalities
  • Chronic uveitis w/in 5 yrs (asymptomatic)

–Occurs in 1/3 of cases

23
Q

What leads to the early growth abnormalities in pauci JIA?

A

Generalized inflammation

24
Q

What are the lab findings in Pauci articular JIA

Pay special attention to RF and ANA

ESR

CBC

RF

ANA

A
  • ESR - increased or wnl
  • CBC:

–Hb/Hct - wnl

–WBC - wnl

–Platelets - wnl

  • RF - neg
  • ANA - freq + (40-75%)
25
Q

Long term prognosis of Pauci JIA is good and early detection and treatment is important but what are some complications

A

–Alteration in growth of affected limb

–2/3 develop iridocyclitis in both eyes

Dr Told said blindness is common

26
Q

How do you manage Classic Pauci?

WHich one is very important and you must know.

A
  • Splinting
  • PT & OT
  • NSAIDs
  • Local corticosteroid injections

–controversial

•Frequent ophthalmologic assessment & tx- this is the important one

27
Q

SO we talked about classic pauci immune JIA

WHat is type II?

A

Juvenile Spondyloarthropathy

28
Q

So Type 1 was 6 y/o or less, what is the characteristics of type II pauci JIA?

A

•Age: > 9 years, M > F

29
Q

WHat are some clinical feature of type II pauci

A
  • Peripheral arthritis primarily in lower extremities
  • Enthesopathies
  • Acute iritis
  • Sacroiliac pain in some
  • Axial disease in some
30
Q

What is this

A

Enthesopathy

31
Q

What is the notable lab finding in pauci type II, try to get this one but if you want the others too

A
  • ESR - wnl to high
  • CBC - wnl
  • RF - neg
  • HLA-B27 + must know this one
32
Q

What % of kids will develop •spondylitis, hip and cervical problems in type II pauci JIA

A

1/3, otherwise prognosis is good

33
Q

Here is the management for type II pauci

What should you note about one of these treatments?

  • PT & OT
  • Posture training
  • NSAIDs
  • ? Anti-TNF agents
  • Local corticosteroid injections
  • Hip arthroplasty
  • Ophthalmologic examination & follow-up
A

Be careful in kids with the steroid injections.

34
Q

Type III pauci is psoriatic, what are some characteristics of it?

A
  • Age: ~8 years, F>M
  • Family History of psoriasis
  • Rarely systemic
35
Q

What are some clinical features of type III pauci

A
  • Occasional severe destructive arthritis
  • Dactylitis (swollen/inflamed digit)
  • Asymmetric peripheral joints
  • Psoriatic rash, nail pitting/onycholysis
  • Flexor tenosynovitis
36
Q

ESR, CBC, RF, ANA in type III pauci?

A
  • ESR - varies with # of joints, may be high
  • CBC: Hb/Hct - (+/-) low, WBC - (+/-) inc
  • RF - neg
  • ANA - ? +
37
Q

What is the course and prognosis of type II pauci?

A
  • Young onset (+/-) associated with iritis
  • Remitting & relapsing, even into adulthood
  • Occasionally severely destructive
  • Occasionally spondylitis develops
38
Q

How would you manage type III pauci

Its basically the same except for 1 thing I hope you think of.

A
  • PT & OT
  • Splinting
  • NSAIDs
  • May require immunosuppression- this the the main difference –Methotrexate (MTX)
  • Biologic Agents

–anti-TNF, IL-1ra

39
Q

Polyarticular JIA has 2 subtypes what are they and severity?

How many joints are involved?

A
  • RF (+) à adolescent, severe, similar to adults
  • RF (–) à milder disease

>5 joints

40
Q

Polyarticular JIA RF neg is in •Any age, occasionally < 1 year, F > M what are the clinical features?

Joints

ROM

fever

is anything enlarged

A
  • Can affect any joint (K, W, A, PIP & DIP)
  • Reduced neck & TMJ ROM
  • Flexor tenosynovitis
  • +/- low grade fever
  • Mild lymphadenopathy & hepatosplenomegaly
41
Q

What is the ESR

CBC

RF

ANA

in polyarticular JIA RF neg

one of these you must know

A
  • ESR - increased, must know this one
  • CBC:

–Anemia

–Mild leukocytosis

–Thrombocytosis

  • RF - negative
  • ANA - occas. positive
42
Q

Recurrant episodes of polyarticular RF neg JIA cause what

A

Progressive deformaties

course otherwise if variable but generally good

43
Q

How do you manage RF neg?

A
  • Splinting to prevent deformity
  • PT/OT to maintain & improve joint & muscle function
  • NSAIDs
  • DMARDs
  • Anti-TNF Agents
44
Q

Characteristics of RF pos

age/sex

A

•> 8 years @ onset, F > M

45
Q

What are some clinical features of RF pos

JOints

Skin finding

Vessel thing

A
  • Polyarthritis of any joint (small joints of W, H, A, F; K & H early)
  • Rheumatoid nodules
  • Vasculitis - uncommon & late
46
Q

Why should you be careful with HVLA in RF pos?

A

cervical sublaxation

ondontoid process erosion

47
Q

What will be your lab test results for RF pos

ESR

CBC

RF

ANA

HLA-DR4

X rays

A
  • ESR – increased
  • CBC: moderate anemia
  • RF – positive, high titre
  • ANA – may be positive
  • HLA-DR4 – frequently positive
  • X-rays – early erosive changes
48
Q

What is the course and prognosis of RF pos

A

•Persistent - serious joint destruction & poor function

49
Q

What are some additional long term hazards of RF pos

A
  • C1-C2 subluxation
  • aortic insufficiency & amyloidosis
50
Q

Management of RF pos

A
  • Splinting
  • PT & OT
  • NSAIDs
  • DMARDs (MTX)
  • Biologic Agents (anti-TNF)
  • Surgical intervention
51
Q

What are some treatments of JIA?

Hint I am really looking for the ones that are FDA approved in children*

A
  • NSAIDs*
  • Gold*
  • Antimalarials
  • Sulfasalazine*
  • Methotrexate
  • Azathioprine
  • Anti-TNF Agents (Etanercept)*
  • Steroids
  • Adjunctive treatments
52
Q

Overall in management of JIA what should you really watch

A

The eye, duh WATCH that eye

53
Q
A

MSK II - Exam 2 (7 decks)

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