Juvenile Arthritis - Told

Question 1

juvenile arthritis

Answer 1

called juvenile idiopathic arthritis

Question 2

pauci

Answer 2

<5 joints

Question 3

5 or 6 joints

Answer 3

extended pauci

Question 4

poly

Answer 4

> 6 joints

Question 5

2-4 joints

Answer 5

olig

Question 6

JIA demographics

Answer 6

onset usually <9yo

Question 7

diagnosis of JIA

Answer 7

age 6months

arthritis 1 or more joints

Question 8

subtypes of JIA

Answer 8

systemic onset
pauciarticular - 1, 2, 3
polyarticular - RF + or -

Question 9

morning stiffness

Answer 9

think RA

Question 10

pauciarticular type 1

Answer 10

classic

Question 11

pauciarticular type 2

Answer 11

spondylitic - only back

enthesis related

Question 12

pauciarticular type 3

Answer 12

psoriatic - nail and skin exam necessary

RF negative

Question 13

growing pain

Answer 13

age 6-13 years
thigh, calf, shin localized - not joints
pain at night
correlated with strenuous exertion
tx - heat, massage, analgesics

Question 14

stills disease

Answer 14

systemic JIA

malaise, fever**, rash,a denopathy, hepatosplenomegaly, serositis, hepatitis, DIC, anemia

5yo F > M

Question 15

fever in systemic JRA

Answer 15

waxes and wanes

Question 16

JRA rash

Answer 16

salmon pink
circumscribed pink
2-6mm or greater

chest, axilla, upper arms
often itchy

Question 17

labs of systemic JIA

Answer 17

high ESR
anemia, leukocytosis (polys), thrombocytosis
RF negative**

Question 18

younger age of systemic JIA

Answer 18

worse prognosis

Question 19

amyloidosis

Answer 19

with persistent systemic JIA

Question 20

most common pauciarticular disease

Answer 20

subtype 1

age M

Question 21

clinical of type I pauciarticular

Answer 21

<5 joints - knee, ankle, elbow, hip

early growth abnormalities

chronic uveitis** within 5 years

Question 22

labs of type I pauciarticular

Answer 22

ESR increased or wnl
CBC normal
RF negative
ANA positive**
HLA A2, DR5, DRw6 and Drw8

Question 23

iridocyclitis

Answer 23

develops in 2/3 of type I pauciarticular disease

need opthalmolgic consult

Question 24

juvenile spondyloarthropathy

Answer 24

pauciarticular type II

Question 25

pauciarticular type II clinical

Answer 25

age >9yo M>F peripheral arthritis enthesopathies acute arthritis

Question 26

labs of pauciarticular type II

Answer 26

ESR normal or high CBC normal RF negative HLA-B27 positive**

Question 27

psoriatic

Answer 27

pauciarticular type III

Question 28

pauciarticular type III clinical

Answer 28

F>M 8yo fam hx of psoriasis rarely systemic ``` dactylitis - swollen digits psoriatic rash - extensor surfaces nail pits onchylosis flexor tenosynovitis ``` remitting and relapsing - even into adulthood

Question 29

pauciarticular type III labs

Answer 29

ESR varies CBC variable RF negative

Question 30

polyarticular JRA

Answer 30

>5 joints RF positive - more severe disease

Question 31

RF negative polyarticular

Answer 31

M ``` any joint reduced neck and TMJ ROM flexor tenosynovitis low grade fever possible mild lymphadenopathy/hepatosplenomegaly ```

Question 32

labs with RF negative polyarticular

Answer 32

ESR increase CBC - anemia, leukocytosis, thrombocytopenia RF negative

Question 33

RF positive polyarticular

Answer 33

>8yo and F>M polyarthritis of any joints rheumatic nodules** vasculitis - uncommon and late

Question 34

cervical subluxation

Answer 34

RF positive polyarticular

Question 35

RF positive polyarticular labs

Answer 35

``` ESR increased CBC moderate anemia RF positive** ANA may be positive HLA-DR4 - frequently positive ``` X-ray erosive changes

Question 36

tx of RF positive polyarticular

Answer 36

NSAIDs gold sulfasalfazine etanercept

Question 37

prognosis of polyarticular RF positive

Answer 37

serious joint destruction and poor function cervical subluxation aortic insufficiency and amyloidosis