Chapter 05.3 Juvenile Idiopathic Arthritis Flashcards Preview

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Flashcards in Chapter 05.3 Juvenile Idiopathic Arthritis Deck (16):
1

Juvenile Idiopathic Arthritis: JIA affects bone and joints. It can lead to overgrowth, undergrowth, or aberrant growth. Possible anomalies related to JIA include ________, leg length ________, and hip ________.

Juvenile Idiopathic Arthritis: JIA affects bone and joints. It can lead to overgrowth, undergrowth, or aberrant growth. Possible anomalies related to JIA include micrognathia, leg length discrepancy, and hip dysplasia.

2

Juvenile Idiopathic Arthritis: JIA is the most common rheumatic disease of childhood
Diagnosis should fulfill the following criteria:
occur before age ________ years.
persist for at least ________ weeks.
diagnosis of ________.

Juvenile Idiopathic Arthritis: JIA is the most common rheumatic disease of childhood
Diagnosis should fulfill the following criteria:
occur before age 16 years.
persist for at least 6 weeks.
diagnosis of exclusion.

3

Indicators of poor outcome for Juvenile Idiopathic Arthritis include:
Greater severity and extension at the onset of disease.
________ disease.
Early ________ and ________ involvement.
________ evidence of RF.
Persistent active disease.
Early radiographic changes.

Indicators of poor outcome for Juvenile Idiopathic Arthritis include:
Greater severity and extension at the onset of disease.
Symmetrical disease.
Early wrist and hip involvement.
Serologic evidence of RF.
Persistent active disease.
Early radiographic changes.

4

There are seven subtypes of Juvenile Idiopathic Arthritis, JIA:
________ arthritis.
________.
RF-negative ________.
RF-positive arthritis.
________ arthritis.
________-related arthritis.
Undifferentiated arthritis.

There are seven subtypes of Juvenile Idiopathic Arthritis, JIA:
Systemic arthritis.
Oligoarthritis.
RF-negative polyarthritis.
RF-positive arthritis.
Psoriatic arthritis.
Enthesitis-related arthritis.
Undifferentiated arthritis.

5

Systemic Arthritis
Diagnosis requires both
Presence of arthritis.
Arthritis preceded by ________ (periodic spike to ________° F) or at least ________ weeks of fever.

Systemic Arthritis
Diagnosis requires both
Presence of arthritis.
Arthritis preceded by fever (periodic spike to 102° F) or at least 2 weeks of fever.

6

Systemic Arthritis
One or more of the following signs:
________ ________-colored rash.
________.
Hepatomegaly.
Splenomegaly.
Serositis.

Systemic Arthritis
One or more of the following signs:
Evanescent salmon-colored rash.
Lymphadenopathy.
Hepatomegaly.
Splenomegaly.
Serositis.

7

A small subset of children can develop ________ ________ syndrome, a life-threatening complication.
Half of the patients with systemic JIA follow a relapsing–remitting course with good long-term prognosis.
Another half have unremitting course with poor clinical and functional prognosis leading to joint destruction.

A small subset of children can develop macrophage activation syndrome, a life-threatening complication.
Half of the patients with systemic JIA follow a relapsing–remitting course with good long-term prognosis.
Another half have unremitting course with poor clinical and functional prognosis leading to joint destruction.

8

Oligoarthritis
Two subtypes
________ (four joints affected).
________ (more than four joints after first 6 months).
Early onset before ________ years of age, asymmetric predominately in females, and good outcome. Presence of ANA is a risk factor for the development of ________.
Silent ________ can develop within 4 years of the onset of the disorder.

Oligoarthritis
Two subtypes
Persistent (four joints affected)
Extended (more than four joints after first 6 months)
Early onset before 6 years of age, asymmetric predominately in females, and good outcome. Presence of ANA is a risk factor for the development of iridocyclitis.
Silent uveitis can develop within 4 years of the onset of the disorder.

9

Polyarthritis
Affects ________ or more joints.
RF positive: affects adolescent ________, ________ joint involvement.
RF negative: variable outcome in the subset of ANA-positive patients; development of chronic ________ is possible.

Polyarthritis
Affects five or more joints.
RF positive: affects adolescent girls, symmetric joint involvement.
RF negative: variable outcome in the subset of ANA-positive patients; development of chronic uveitis is possible.

10

Psoriatic Arthritis
Diagnostic criteria:
Presence of arthritis and ________ rash.
If rash is absent, a positive history of psoriasis in a first-degree relative, ________, and nail ________.

Psoriatic Arthritis
Diagnostic criteria:
Presence of arthritis and psoriatic rash.
If rash is absent, a positive history of psoriasis in a first-degree relative, dactylitis, and nail pitting.

11

Enthesitis-Related Arthritis
Affects ________-________-positive males after ________ years of age.
Enthesitis locations:
Calcaneal insertion of the ________ tendon.
________ fascia.
________ area.
________ involvement (common).
The disease may progress to ________ ________.

Enthesitis-Related Arthritis
Affects HLA-B27-positive males after 6 years of age.
Enthesitis locations:
Calcaneal insertion of the Achilles tendon.
Plantar fascia.
Tarsal area.
Hip involvement (common).
The disease may progress to ankylosing spondylitis.

12

JUVENILE ANKYLOSING SPONDYLITIS
Not part of JIA subclassification.
Associated with HLA-________.
Affects adolescent ________.
________ and episodic ________.
________ joint involvement.
“________” spine.

JUVENILE ANKYLOSING SPONDYLITIS
Not part of JIA subclassification.
Associated with HLA-B27.
Affects adolescent boys.
Oligoarthritis and episodic asymmetric.
Sacroiliac joint involvement.
“Bamboo” spine.

13

PRINCIPLES OF REHABILITATION OF CHILDREN WITH JIA
Prevent ________ damage.
Achieve normal ________ and ________.
Maintain and improve ________.
Treatment includes ________ the joint, ________ in functional position, ________, ________, and adaptive equipment.
Ultrasound is contraindicated in children with open growth plates.

PRINCIPLES OF REHABILITATION OF CHILDREN WITH JIA
Prevent joint damage.
Achieve normal growth and development.
Maintain and improve function.
Treatment includes resting the joint, splinting in functional position, ROM, modalities, and adaptive equipment.
Ultrasound is contraindicated in children with open growth plates.

14

SPECIAL CONSIDERATIONS
Joints.
________ spine is more often involved than in adults.
________ is commonly affected and can lead to mandibular and facial growth disturbance (polyarticular form).
Wrist involvement is common and requires splinting, ROM, and modalities.
Shoulder joint involved in polyarticular and psoriatic arthritis.
Hip ________ contractures with ________ rotation and ________ unlike adults.
________ is the most commonly involved joint; quadriceps weakness due to early contracture may not resolve (active quad strengthening is recommended).
Leg length discrepancy due to bony overgrowth can lead to pelvic asymmetry and scoliosis.

SPECIAL CONSIDERATIONS
Joints.
Cervical spine is more often involved than in adults.
TMJ is commonly affected and can lead to mandibular and facial growth disturbance (polyarticular form).
Wrist involvement is common and requires splinting, ROM, and modalities.
Shoulder joint involved in polyarticular and psoriatic arthritis.
Hip flexion contractures with internal rotation and adduction unlike adults.
Knee is the most commonly involved joint; quadriceps weakness due to early contracture may not resolve (active quad strengthening is recommended).
Leg length discrepancy due to bony overgrowth can lead to pelvic asymmetry and scoliosis.

15

FIRST LINE Treatment
________ in initial phase.
________ intra-articular joint injections.
Up to ________% of children may achieve remission with ________ and ________.

FIRST LINE Treatment
NSAIDs in initial phase.
Steroid intra-articular joint injections.
Up to 75% of children may achieve remission with NSAIDs and methotrexate.

16

SECOND LINE Treatment
________ inhibitors (________ and ________).
T-cell blockers (________) for TNF inhibitor nonresponders.

SECOND LINE Treatment
TNF inhibitors (etanercept and adalimumab).
T-cell blockers (abatacept) for TNF inhibitor nonresponders.