JIA-LM Flashcards by Stephen Schaffner

what is JIA also know as/previously

Synonyms:

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

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tHERE IS NO single best what for JIA

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

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

mono=1

oligo=2-4

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extended pauci has how many hot joints

5-6

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what about poly arthritis?

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what is a hot joint?

•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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What is the age demographic of JIA

<9 y/o

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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

Age at onset < 17 years
Arthritis in 1 or more joints
Duration of disease > 6 weeks
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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What are the 3 main types of JIA

What are the % occurances of each?

Systemic 10-15

Pauciarticuar (oligoarticular) 50%+

Polyarticular 30-40%

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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?

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

What are some signs and symptoms that are systemic?

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

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MSK sym of Still’s

–Arthritis, myalgia, arthralgias

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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.

–Usually < 5 yoa

If < 5 yoa F=M
If > 5yoa F>M

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Describe the fever in Systemic JIA.

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

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What is this?

fusiform or spindle form fingers from systemic JIA

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

color

shape

size

distribution

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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What will the ESR be in Systemic JIA?

CBC would show what?

Dr Told said all your inflammatory markers should be up.

ESR - high
CBC

–Anemia

–Leukocytosis (inc. polys

–Thrombocytosis

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What is the IgM RF and ANA in systemic JIA?

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What confers a worse prognosis on Systemic JIA?

If the disease persist what could happen

youger the age of onset.

Amyloidosis in some children

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

Splinting

PT/OT

NSAIDS

Steroids in what cases? Severe, right on Steve

DMARDS with questional benefit.

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What age and sex are common in pauci articular JIA

F>M

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What are some clinical features of pauci?

How many and which joints

how do they grow?

etc

Study These Flashcards

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

–Occurs in 1/3 of cases

What leads to the early growth abnormalities in pauci JIA?

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Generalized inflammation

What are the lab findings in Pauci articular JIA

Pay special attention to RF and ANA

ESR

CBC

ANA

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ESR - increased or wnl
CBC:

–Hb/Hct - wnl

–WBC - wnl

–Platelets - wnl

RF - neg
ANA - freq + (40-75%)

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

–Alteration in growth of affected limb –2/3 develop iridocyclitis in both eyes Dr Told said blindness is common

How do you manage Classic Pauci? WHich one is very important and you must know.

* Splinting * PT & OT * NSAIDs * Local corticosteroid injections –controversial •Frequent ophthalmologic assessment & tx- this is the important one

SO we talked about classic pauci immune JIA WHat is type II?

Juvenile Spondyloarthropathy

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

•Age: \> 9 years, M \> F

WHat are some clinical feature of type II pauci

* Peripheral arthritis primarily in lower extremities * Enthesopathies * Acute iritis * Sacroiliac pain in some * Axial disease in some

What is this

Enthesopathy

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

* ESR - wnl to high * CBC - wnl * RF - neg * HLA-B27 + must know this one

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

1/3, otherwise prognosis is good

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

Be careful in kids with the steroid injections.

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

* Age: ~8 years, F\>M * Family History of psoriasis * Rarely systemic

What are some clinical features of type III pauci

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

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

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

What is the course and prognosis of type II pauci?

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

How would you manage type III pauci Its basically the same except for 1 thing I hope you think of.

* PT & OT * Splinting * NSAIDs * May require immunosuppression- this the the main difference –Methotrexate (MTX) * Biologic Agents –anti-TNF, IL-1ra

Polyarticular JIA has 2 subtypes what are they and severity? How many joints are involved?

* RF (+) à adolescent, severe, similar to adults * RF (–) à milder disease \>5 joints

Polyarticular JIA RF neg is in •Any age, occasionally \< 1 year, F \> M what are the clinical features? Joints ROM fever is anything enlarged

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

What is the ESR CBC RF ANA in polyarticular JIA RF neg one of these you must know

* ESR - increased, must know this one * CBC: –Anemia –Mild leukocytosis –Thrombocytosis * RF - negative * ANA - occas. positive

Recurrant episodes of polyarticular RF neg JIA cause what

Progressive deformaties course otherwise if variable but generally good

How do you manage RF neg?

* Splinting to prevent deformity * PT/OT to maintain & improve joint & muscle function * NSAIDs * DMARDs * Anti-TNF Agents

Characteristics of RF pos age/sex

•\> 8 years @ onset, F \> M

What are some clinical features of RF pos JOints Skin finding Vessel thing

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

Why should you be careful with HVLA in RF pos?

cervical sublaxation ondontoid process erosion

What will be your lab test results for RF pos ESR CBC RF ANA HLA-DR4 X rays

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

What is the course and prognosis of RF pos

•Persistent - serious joint destruction & poor function

What are some additional long term hazards of RF pos

* C1-C2 subluxation * aortic insufficiency & amyloidosis

Management of RF pos

* Splinting * PT & OT * NSAIDs * DMARDs (MTX) * Biologic Agents (anti-TNF) * Surgical intervention

What are some treatments of JIA? Hint I am really looking for the ones that are FDA approved in children\*

* NSAIDs\* * Gold\* * Antimalarials * Sulfasalazine\* * Methotrexate * Azathioprine * Anti-TNF Agents (Etanercept)\* * Steroids * Adjunctive treatments

Overall in management of JIA what should you really watch

The eye, duh WATCH that eye

JIA-LM Flashcards

(53 cards)