6.4. Rheumatology - Juvenile Idiopathic Arthritis Flashcards Preview

3rd Year - MSK Diseases > 6.4. Rheumatology - Juvenile Idiopathic Arthritis > Flashcards

Flashcards in 6.4. Rheumatology - Juvenile Idiopathic Arthritis Deck (36):
1

What is Juvenile Idiopathic Arthritis?

A group of systemic inflammatory disorders affecting children below the age of 16 years

2

What is the most common Rheumatic Disease in Children?

Juvenile Idiopathic Arthritis
Note - This is an important cause of disability and blindness

3

What type of disease is Juvenile Idiopathic Arthritis?

Autoimmune

4

What is the Aetiopathogenesis of Juvenile Idiopathic Arthritis?

Multifactorial:
1. Genetic
2. Environmental
3. Immunological
Note - This is different from Adult Rheumatoid Arthritis

5

What is the pathology of Juvenile Idiopathic Arthritis?

Environmental Factors act on Strong Subset-Specific Genetic Markers, which may affect the Immune Response

6

What is the Criteria for Diagnosis of Juvenile Idiopathic Arthritis?

1. Age of Onset (<16 years old)
2. Duration of the Disease (>6 weeks)
3. Presence of Arthritis

7

In the Criteria for Diagnosis of Juvenile Idiopathic Arthritis, what confirms the presence of Arthritis?

Joint Swelling
Or 2 of the following:
1. Painful or Limited Joint Motion
2. Tenderness
3. Warmth

8

How many Clinical Subtypes of Juvenile Idiopathic Arthritis are there?

3

9

What are the 3 Clinical Subtypes of Juvenile Idiopathic Arthritis?

1. Pauciarticular (55%)
2. Polyarticular (25%)
3. Systemic Onset (20%)

10

What can the Clinical Subtype of Juvenile Idiopathic Arthritis help us suspect?

1. The Natural History
2. Complications
3. Prognosis
4. Decide the Strategy of Treatment

11

What does Pauciarticular Juvenile Idiopathic Arthritis involve?

Rheumatoid Arthritis of 4 or less Joints

12

How many Types of Pauciarticular Juvenile Idiopathic Arthritis are there?

3:
1. Type 1 Pauciarticular Juvenile Idiopathic Arthritis
2. Type 2 Pauciarticular Juvenile Idiopathic Arthritis
3. Type 3 Pauciarticular Juvenile Idiopathic Arthritis

13

What is the percentage breakdown of each of the Main Types of Pauciarticular Juvenile Idiopathic Arthritis?

1. Type 1 - 25%
2. Type 2 - 15%
3. Type 3 - 15%

14

How does Type 1 Pauciarticular Juvenile Idiopathic Arthritis commonly present?

1. With a limp rather than pain
2. No other Constitutional Manifestations
3. Chronic Uveitis in 20% of cases
4. Asymptomatic in 50% of cases
5. Irregular Iris due to Posterior Synechiae

15

Which Joints are most commonly affected in Type 1 Pauciarticular Juvenile Idiopathic Arthritis?

Mainly Lower Limb Joints (most common down):
1. Knee
2. Ankle
3. Hand (Rare)
4. Elbow (Rare)
5. Hip (Very Rare)

16

Who commonly gets Type 1 Pauciarticular Juvenile Idiopathic Arthritis?

1. Girls (8:1)
2. Younger than 5 years old

17

Who commonly gets Type 2 Pauciarticular Juvenile Idiopathic Arthritis?

1. Boys (7:1)
2. Ages after 8 / 9

18

What condition is seen in 10-20% of Type 2 Pauciarticular Juvenile Idiopathic Arthritis patients?

Acute Iridocyclitis (Inflammation of the Iris)

19

How does Type 2 Pauciarticular Juvenile Idiopathic Arthritis commonly present?

1. Limp due to Lower Limb affection
2. Consitutional Symptoms are Rare

20

Which Joints are most commonly affected in Type 2 Pauciarticular Juvenile Idiopathic Arthritis?

Mainly Lower Limb:
1. Knee
2. Ankle
3. Hip

21

How are those with HLA-B27 Positive Back Involvement categorised as?

Juvenile Ankylosing Spondylitis

22

How does Type 3 Pauciarticular Juvenile Idiopathic Arthritis present?

1. Asymmetric Upper Limb and Lower Limb Arthritis
2. Dactylitis (Inflammation of the Toes / Fingers)
3. Constitutional Symptoms are Rare

23

Who commonly gets Type 3 Pauciarticular Juvenile Idiopathic Arthritis?

1. Girls (4:1)
2. This develops at Any Age (Before 16)

24

What conditions are associated with Type 3 Pauciarticular Juvenile Idiopathic Arthritis?

1. Chronic Iridocyclitis in 10-20% of patients (Inflammation of the Iris)
2. Psoriasis (Later in life)
Note - this condition is more likely with a Family History of Psoriasis

25

What percentage of Pauciarticular Juvenile Idiopathic Arthritis go on to develop Polyarticular Juvenile Idiopathic Arthritis?

30%

26

How many Joints are involved in Polyarticular Juvenile Idiopathic Arthritis?

5 or more

27

What are the 2 Sub-types of Polyarticular Juvenile Idiopathic Arthritis?

1. Rheumatoid Factor Positive Polyarticular Juvenile Idiopathic Arthritis
2. Rheumatoid Factor Negative Polyarticular Juvenile Idiopathic Arthritis

28

How does Rheumatoid Factor Positive Polyarticular Juvenile Idiopathic Arthritis present?

1. Symmetric Large and Small Joints affection (Knee, Wrist, Ankle, MCP, PIP, Neck)
2. Consitutional Manifestations (Fever, Malaise...)
3. Hepato-Splenomegaly
4. Mild Anaemia
5. Growth Abnormalities
6. Iridocyclitis (Inflammation of the Iris) (Rare)

29

Who commonly gets Rheumatoid Factor Positive Polyarticular Juvenile Idiopathic Arthritis?

1. Girls (9:1)
2. This can present at any age (below 16)
Note - This accounts for 15% of all Juvenile Idiopathic Arthritis

30

How does Rheumatoid Factor Negative Polyarticular Juvenile Idiopathic Arthritis present?

Similar to Adult Rheumatoid Arthritis:
1. Constitutional Manifestations (Fever, Malaise...)
2. Anaemia
3. Nodules
4. Iridocyclitis (Inflammation of the Iris) (Rare)
5. Erosions in X-Ray occur early

31

Who commonly gets Rheumatoid Factor Negative Polyarticular Juvenile Idiopathic Arthritis?

1. Girls (7:1)
2. In late Childhood (12-16 years)
Note - This accounts for 10% of all Juvenile Idiopathic Arthritis

32

What is the most Serious type of Juvenile Idiopathic Arthritis?

Systemic Onset of Juvenile Idiopathic Arthritis
Note - This has short and long term morbidity and mortality

33

Who commonly gets Systemic Onset of Juvenile Idiopathic Arthritis?

1. Girls (3:2)
2. At any age throughout childhood but mainly at 4-6 years olf

34

What Joints does Systemic Onset of Juvenile Idiopathic Arthritis commonly affect?

1. Wrists
2. Knees
3. Ankles
4. Cervical Spine
5. Hips
6. TMJ

35

How does Systemic Onset of Juvenile Idiopathic Arthritis present?

1. Arthritis
2. Fever (within 3-12 months of onset)
3. Salmon Red Eruption on the Trunk / Thighs
4. Polyseositis (Pleural Effusion / Pulmonary Fibrosis / Pericarditis)
5. Lymphadenopathy
6. Abdominal Pain (+/- Transaminases)

36

What is the Therapy for Juvenile Idiopathic Arthritis?

1. Simple Pain Killers (NSAID's)
2. Joint (Steroid) Injections
3. Methotrexate
4. Biologics (Anti-TNF, IL-1 Antagonist, IL-6 Antagonist)
5. Local / Systemic Steroids
6. Rehabilitation / Occupational Therapy
7. Surgical (Synovectomy / Reconstructive)

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