JIA

Question 1

Diagnosis by ARA

Answer 1

Onset before 16
Sx must persist min 6 weeks
Arthritis in 1 or more joints (defined as swelling within a joint or limitation in the ROM with joint pain or tenderness)
Exclusion of other diseases

Question 2

Etiology

Answer 2

Autoimmune, multifactorial inheritance (genetics + environmental trigger), involvement of T-cells & HLA genes

Question 3

Is there a lab test to diagnose JIA?

Answer 3

No.

Question 4

When does a child get assigned to a subtype?

Answer 4

After 6 mo of active disease

Question 5

What are the 7 subtypes?

Answer 5

Oligoarticular persistent and extended
Seronegative Polyarticular
Seropositive Polyarticular
Systemic
Psoriatric
Enthesitis
Undifferentiated

Question 6

How many joints are affected in Oligoarticular JIA

Answer 6

4 or fewer (50% have only 1)

Question 7

What joints are often affected with Oligoarticular JIA?

Answer 7

KNEE, ankle, wrist (often asymmetric joint involvement)

Question 8

What is the most common kind of JIA?

Answer 8

Oligoarticular JIA

Question 9

What other condition is common with Oligoarticular JIA?

Answer 9

Iridocyclitis (anterior uveitis) - may be asymptomatic

Question 10

What is Persistent Oligoarticular JIA?

Answer 10

Affects no more than 4 joints throughout the course of the disease

Question 11

What is Extended Oligoarticular JIA?

Answer 11

Affects more than 4 joints after the first 6 mo of the disease

Question 12

How many joints need to be affected to be considered Polyarticular JIA?

Answer 12

5 or more joints

Question 13

What joints are affected in Polyarticular JIA?

Answer 13

Knees, ankles, elbows, wrists, cervical spine and TMJ

Question 14

What are the subtypes of Polyarticular JIA?

Answer 14

Seronegative (RF-) & Seropositive (RF+)

Question 15

Peak ages and type of joint involvement in Seronegative Polyarticular JIA

Answer 15

2-4 & 6-12 y.o.

ASYMMETRIC

Question 16

Peak ages and type of joint involvement in Seropositive Polyarticular JIA

Answer 16

Girls in late childhood/early adolescence.
SYMMETRIC - similar to adult RA
(wrists/small joints in hands/feet)

Question 17

Severe constitutional symptoms of Systemic JIA

Answer 17

High Spiking fever
Salmon colored rash (tunk/proximal extremities)
Hepatosplenomegaly
Pleuritis
Pericarditis
Lymphadenopathy

Question 18

What is the life threatening syndrome associated with Systemic JIA?

Answer 18

MAS (macrophage activation system) - activation of T cells and macrophages leads to overwhelming inflammatory response

Question 19

When does joint pain develop with Systemic JIA?

Answer 19

Later in the process. 25-50% develop significant joint destruction

Question 20

Common clinical manifestations

Answer 20

Morning "gelling"/after immobility
IL-1 & tumor necrosis factor alpha (mediates joint damage)
Pannus formation 
Ligamentous Laxity
Decreased ROM
Dec Physical Activity/Weakness
Osteopenia
Growth disturbance
Micrognathia

Question 21

Medical Treatment

Answer 21

NSAID
DMARDS (methotrexate)
Anti-malarial (Plaquenil)
Gold Salts
Corticosteroids
Biologic Agents

Question 22

Methotrexate

Answer 22

Gold standard, Treats all types except systemic

Question 23

What is inactive disease?

Answer 23

No joints with active arthritis
No fever, rash, serositis
No active uveitis/eye inflammation
Normal CRP and ESR
No disease activity on physician global assessment of disease activity

Question 24

What is clinical remission on medication?

Answer 24

criteria for inactive disease are met for a minimum of 6 continuous months while on meds

Question 25

What is clinical remission off medication?

Answer 25

criteria for inactive disease are met for a minimum of 12 continuous months off meds

Question 26

Whats one of the first things a parent might notice with JIA?

Answer 26

Decreased activity, not wanting to play etc (d/t pain)

Question 27

Pediatric pain scales

Answer 27

``` NIPS - babies FLACC- birth+, developmentally delayed (excluding paralyzed or those with spasticity) Oucher - ages 3 to 12 Faces Pain Rating Scale VAS COMFORT - unconscious/ventilator ```

Question 28

What should you assess with a child with JIA?

Answer 28

``` The joint (look, feel, move, test) ROM Muscle strength (Observation of functional skills, MMT, handheld dynamometer) Posture/gait Functional abilities Physical Fitness ```

Question 29

What is the PEDI-CAT?

Answer 29

Computer Adaptive Test. 3 functional domains & responsibility domain (daily activities, mobility, social-cognitive)

Question 30

What is age range for the Wee-FIM?

Answer 30

6 mo - 7 years may be used with children above 7 as long as their functional abilities (as measured by wee fim) are below those expected of children aged 7 who do not have disabilities

Question 31

How many items and what domains are on the wee-fim

Answer 31

18 items, Self care, mobility, cognition.

Question 32

What are the FIM levels?

Answer 32

No Helper 7 Complete Independence (timely, safe) 6 Modified ind (device) Helper - Modified Dependence 5 Supervision (subject = 100%) 4 Minimal assistance (subject = 75% or more) 3 Moderate assistance (subject = 50% or more) Helper - Complete Dependence 2 Maximal assistance (subject = 25% or more) 1 Total assistance (subject = less than 25%)

Question 33

Juvenile Arthritis Assessment Scale age range

Answer 33

7-16 y.o.

Question 34

What does Juvenile Arthritis Assessment Scale observe?

Answer 34

the child’s actual performance of typical activities under standardized conditions. 10 items - ADLs (dressing, picking up an object off the floor)

Question 35

What is teh Juvenile Arthritis Assessment Scale scale?

Answer 35

``` 0= task performed in less than or equal to criterion time 1= task performed in more time than the criterion time 2= unable to do the task ```

Question 36

Activities Scale for Kids (ASK) age range

Answer 36

5-15 years old

Question 37

What does ASK measure?

Answer 37

Measures physical disability and monitors functional change in children with limitations due to musculoskeletal disorders

Question 38

How many items are on ASK

Answer 38

30 items - scored 0-4

Question 39

What is the ASK scale?

Answer 39

0-4. 0 is with no problem and 4 is the child could not (personal care, dressing, locomotion, play, standing, transfers, other skills)

Question 40

Physical Fitness in pts with JIA

Answer 40

Peak oxygen uptake reduced in comparison to healthy peers Lower peak work rate, peak exercise HR and exercise time Impaired aerobic capacity appears to be related to hypoactivity more so than the severity of the disease

Question 41

Recommendations for physical fitness in pts with JIA

Answer 41

2X/week | Moderate to vigorous intensity (60-85%max HR) for 45-60 minutes for at least 6-12 weeks

Question 42

Tx of acute active joint swelling: AROM

Answer 42

go to point of discomfort and hold 10 reps 2-3x day Proper hand placement to isolate the joint without stressing other joints

Question 43

Tx of acute active joint swelling: isometric exercises

Answer 43

Submax contraction for 6 seconds for 5-6 reps

Question 44

Tx of acute active joint swelling: other

Answer 44

Pain management, splinting/casting, activity modification

Question 45

Tx: resolving joint inflammation

Answer 45

Progress home program Antigravity activities May add light resistance 8-10 reps against gravity without pain (TB, etc) Aquatic therapy Strengthening (observe joint protection principles) Return to activity (consider appropriateness of activities) Continue ROM exercises