JIA

Question 1

What is JIA

Answer 1

Juvenile idiopathic Arthritis

Autoimmune inflammatory disease Diagnosed with onset before 16 - M/C rheumatic disorder Dx in children

Question 2

Risk Factors

Answer 2

Environmental, Immunological, Strong genetic influence

Question 3

Time scale for subtypes

Answer 3

One of three subtypes can be identified after 6 months of condition presenting.

Question 4

Pauciarticular Type I

Answer 4

Onset in 1-3 year old girls >boys (8:1)

can affect any joint but most commonly Knee>ankle>hand/elbow (very rarely hips)
Chronic Uveitis can lead to Secondary Cataract and slow loss of visoon

ANA +ve in 40-75% of cases

Question 5

Pauciarticular type II`

Answer 5

Onset 7-8 year old Boys>girls (7:1)
Lower limb joints Knees and ankles most commonly
acute Idiocyclitis/Iritis
HLA-B27 +ve

Question 6

Pauciarticular type III

Answer 6

Onset at Any age Girls>Boys (4:1) 
Upper limb Joints (asymmetrically) 
Dactylitis (swollen fingers or toes)
FHx of Psoriasis - Pt will develop psoriasis later in life. 
\+/- nail Pitting

Question 7

Polyarticular

Answer 7

Comes as RF +ve and RF -ve

Question 8

RF +ve

Answer 8

Affect 12-16 year old Girls > boys 7:1

Comes with Fever, malaise, nodules and anaemia
Similar to RA in adults
May be secondary to conditions such as CF

Question 9

RF -ve

Answer 9

Onset at any age <16 girls>boys (9:1)

Joint symmetry in affect and comes with Fever malaise HMS, growth abnormality and mild anaemia

Question 10

STILLs Disease

Answer 10

Systemic JIA affecting any number of joints + systemic symptoms.

Question 11

Who does STILLs disease affect

Answer 11

4-6 year old Girls>boys (9:1)

Question 12

How does Stills present

Answer 12

Fever rising to 39.5 degrees - Child appears toxic with fever but it comes in waves and child may appear normal when apyrexic

Salmon Pink eruptions on trunk and thighs (psoriasis in unusual places) - Keobners phenomenon - Brought on by scratching

Generalised Lymphadenopathy (non-tenser) with HSM and Abdo pain

Serositis

Arthritis onset 3-12 months after fever onset. .

Question 13

Ix of JIA

Answer 13

FBC
ESR - Very high in STILLs - does not correlate with disease activity.
ANA
ASTO - Antispretolysis O - Often high with with no correlation
RF

Question 14

Rx of JIA

Answer 14

1st line - NSAIDs - tolerated differently at different ages

2nd line - IA steriods/methotrexate/anti-TNF/IL-1antagonists/IL-6 antagonists (in STILLs)

PT
Synovectomy or Replacement