Juvenile Idiopathic Arthritis Flashcards
(61 cards)
1
Q
What is JIA?
A
- Childhood disease→ swelling, inflamm, pain about jts
- Formerly→ Juvenile Rheumatoid Arthritis (America) and Juvenile Chronic Arthritis (Europe)
2
Q
JIA Defined:
aka what makes it a JIA dx?
A
- Arthritis lasting @ least 6wks
- 1 or more jts
- Children <16yo
- WHEN ALL OTHER CAUSES R/O!!!
3
Q
No neural insult, BUT contractures?
Potential Dx and what to do?
A
Osteoarthritis?
Refer to ortho!!!
4
Q
JIA Dx:
A
- NO true Dx test*
- Mostly clinical and often delayed
- Non-specific signs:
- Mild anemia, elevated erythrocyte sedimentation rate (ESR), radiograph evidence jt swelling, osteopenia
5
Q
JIA Incidence/Prevalence
A
Age of onset/gender vary by type
Girls>Boys
6
Q
JIA Etiology
Unclear BUT…
A
-
Theory of autoimmune inflammatory disorder:
- External trigger→ trauma, bact/virus
- virus/bacterial infx usually precedes onset
- phys. trauma
7
Q
Types of JIA:
5:
A
- Olioarticular (former→ Pauciarticular)
- Polyarticular
- Systemic
- Enthesitis-related
- Psoriatic
8
Q
Olioarticular JIA
fun fact to KNOW!
A
Usually one-side only
9
Q
Olioarticular
A
- 50-60% cases
- Girls <6yo
- Sx’s:
-
Mild inflamm in 4 or fewer jt→ KNEE MOST COMMON*
- ankles, elbows
- *hip/sm. jts of hands not impacted
- Joints→ swollen, warm, not too painful
-
Mild inflamm in 4 or fewer jt→ KNEE MOST COMMON*
- EXCELLENT PROGNOSIS*
10
Q
Olioarticular prognosis
A
EXCELLENT!!!
11
Q
Polyarticular
*less common
A
- 25-28%, 5 or more jts
-
Symmetric→ large AND small jts
- MAY include CS and TMJ*
- Jts→ swollen, warm, echymosis
- *Mild systemic sx’s→ low grade fever, hepatosplenomegaly, lymphadenopathy
- Prognosis→ guarded 2* comps: weakness, contractures
12
Q
Polyarticular prognosis
A
Guarded (unsure) 2* comps may arise→ weakness, contractures
13
Q
MOST SERIOUS JIA
A
SYSTEMIC
14
Q
Dx marker of Systemic JIA
A
High fever
15
Q
Systemic JIA
A
- 10-12%, MOST serious
- Pain in many jts
- Dx marker==> high fever**
- Rash→ trunk, limbs, face, palms, soles feet
- S/S:
- Pleuritis, pericarditis, myocarditis, hepatosplenomegaly, lymphadenopathy
- Prognosis→ mod-poor: more severe+more jts
16
Q
Systemic prognosis
A
Mod-poor bc more severe+many jts
17
Q
Enthesis-related JIA
A
- Effects Enthesis→ area where tendons+ligs attach to bone
- jts also maybe affected
18
Q
Psoriatic JIA
A
- Combination→ Jt tenderness + inflammation w/ psoriasis of skin OR probs w/ nails
19
Q
Cardinal signs of Inflammatory Response:
A
- Swelling, End range stress pain, 2* swelling and protective mm spasms, Jt stiffness, Chronic inflammation==INCd synovial fluid→
- All==> DECd phys activity and low bone density + use of corticosteroids==> INCd fx risk
20
Q
Cardinal signs of Inflammatory Response:
More on Jt Stiffness
A
MOST noted upon waking (AM stiff) OR after prolonged sitting
21
Q
Cardinal signs of Inflammatory Response:
More on Inflamm==> INCd synovial fluid
A
- Stretches/weaknes jt capsule + adj. structures
- Overgrowth, pannus (see pic), spreads/erodes art. cart.==> changes bone surfaces
- Compromises align, symmetry and stability of jts==> contractures
22
Q
Medical Mgmt JIA:
Goals→
A
- Control arthritis, prevent jt erosions, manage extra-articular manifestations
23
Q
Medical Mgmt JIA:
Coordination w/ drugs
A
-
NSAIDs→ most widely used first line
- SEs=> GI issues
- dec fever, pain, inflamm→ DO NOT alter dis. course
24
Q
Medical Mgmt JIA:
Methotrexate (MTX)
A
- MOST COMMON used to modify dis. itself***
- Children w/ systemic and polyarticular
25
Medical Mgmt JIA:
## Footnote
**Last 3 medical mgmt techniques**
Steroids, Total jt replaces, PT\*\*\*
26
PT Exam/**Physical Manifestations of JIA:**
* Jt swell/stiff, pain, limtd mob; soft tissue contractures, AM stiff (better t/o day), mm atrophy/weakness/poor mm endurance, fatigue, decd aerobic cap, osteopenia, gait devs, diff w/ ADLs, act/part restrictions
27
2 Standardized Measures **_specific to JIA:_**
Articular Severity Score (ASS)
Global Range of Motion Score (GROMS)
**ASS and GROMS\*\*\***
28
Jt Examination: JIA
* **Active Jt Motion→** observe child thru series mvmts
* \*\*\***Goniometry recommended!!!**
29
Jt Examination: **Stick figure method**
* Jt counts for **swelling and ROM limits**
* **Add X's into circles**
30
MM Structure and Function
## Footnote
**Mm atrophy and weakness near inflamed joints…**
**SPECIFICALLY WHERE?**
PROXIMALLY
31
MM Structure and Function
* MM atrophy and weakness→ **proximally**
* may persist AFTER flare up controlled
* **Measure/Monitor→** MM bulk, strength, endurance
32
Strength Testing: JIA
* **Functional MM Strength→** observe motor skills and ADLs→ **younger children**
* MMT/dynamometry
* **Dynamic strength test _once flare-ups controlled_\*\*\***
* **Endurance→** how many reps/timed tasks
33
Aerobic Capacity and Function: JIA
## Footnote
**Tests/Assessments to use?**
* 6MWT, Peds RPE\*\*\*
* **LOWER peak workload, peak ex. HR, ex. time vs healthy peers**
34
MAJOR cause of act. limits in JIA
PAIN
35
Pain and JIA
* MAJOR cause act. limits\*\*\*\*, **more prev. as child ages**
* **Ongoing pain assess:**
* pain hx
* Pt self-report→ **4yrs and older**
* **Behaviors→** guarding, bracing, rubbing, rigidity\*
36
Pt self-report pain @ what age?
4 yrs +
37
Pain and JIA
## Footnote
**Pain Scales:**
Wong Baker Faces Scale, Oucher, Body Map (color),
**Children 7yo and older→ VAS**
**Varni/Thompson Peds Pain Questionnaire (PPQ)→** parent AND child reports\*\*\*
38
VAS can be used WHEN for children w/ pain?
7yrs and older
39
Varni/Thompson PPQ
## Footnote
**What to remember?**
Parent AND Child reports of pain
40
Growth Disturbance/Postural Abnorms JIA
* Reduction in growth w/ ext'd pds of active disease\*\*
* systemic steroids exacerbate this
* Osteoporosis
* LLDs common→ asymmetrical, premature closure growth plates
* **Observe posture/alignment in _sitting_ AND _standing_!!!**
41
Gait Impairments in JIA
* Decd velocity, Decd cadence, Limtd stride length, Incd APT,
* Decd hip EXT and PF @ **TSt** and lack of push-off
* **Maybe→** developed weakness, loss of ROM from scar tissue
* **USE→** gait labs, pedographs, video
42
Role of PT in JIA
Depends on ______ and \_\_\_\_\_\_\_
Type; Severity
43
Role of PT depends highly on **type** and **severity** of JIA
## Footnote
**Oliarticular vs Poly**
* **Oliarticular→** FEW functional limits, if any
* **Poly→** need assist w/ basic ADLs, moving bw pos's, stairs, bike, playground w/ peers, etc.
44
Standardized Assessments that **examine child's w/ JIA's _Activity:_**
## Footnote
**2:**
1. **Childhood Health Assessment Questionnaire:**
1. 1-19yo
2. 30 activities
3. parent OR child answers
4. Has **areas to assess length of time for morning stiff and VAS for pain**
2. **Juvenile Arthritis Functional Assessment Index (JASI) and Juvenile Arthritis Functional Assessment Report (JAFAR)**
1. Measures **_physical function_\*\***
45
Participation and Activity Limits contd
## Footnote
**2 more assessments:**
* SFA→ diff @ school
* **Juvenile Arthritis Functional Assessment Scale (JAFAS)**
* observed and timed on 10 tasks
46
Participation/Activity Limits
## Footnote
**QoL Measures to use:**
* Juvenile Arthritis Quality of Life Questionnaire (JAQQ)
* Pediatric Quality of Life Questionnaire (PedsQL)
47
PT Interventions:
## Footnote
**Goals + guidelines**
* **Goals→** prevent/min. impairs, maint or improve function, edu/support for pt and fam
* Phys activity and **graded exercise**
* Adherence to HEP **CRUCIAL!!!**
48
PT Rx for Pain Control
* Anti-inflamms→ may take time
* Intra-articular steroid injections
* **PRICE:**
* **P**ain control
* **R**est
* **I**ce
* **C**ompression
* **E**levation
49
PT Rx for Pain Control
## Footnote
**Modalities:**
* Superficial heat (20 mins), paraffin, biofeedback, imagery/meditation, imagination play
* **\*NOTE: US NOT USED FOR THIS POPULATION!!!**
50
Education on _________ is **super important!!!!**
_Prevention_ of **AM stiffness\*\*\***
51
EDUCATE! EDUCATE! EDUCATE!
* Regarding **_prevention of AM stiffness_\*\*\* (KNOW FOR TEST!!!)**
* Night splints, main. body heat t/o night, pre-bed exercises or parental massage, AM warm bath/mvmt before school
* sleeping bags, extra layers
52
Managing Joint Impairments
## Footnote
**Utilizing ROM program**
* “Motion is Lotion”→ Daily ROM program
* thru FULL ROM 1-2x/day
* AROM preferable, AAROM if weakness
* Gental manual stretch when **arthritis under control**
* brief 60s, contract release
* Child moves limb thru full ROM after stretch bc mm in **lengthened state**
* Serial casting, spinting/orthoses→ **prolonged stretch/pos'ing in more severe/contracted jts**
53
Strengthening in JIA
* **Target mm's _surrounding effected jts_\*\***
* **During acute inflamm:**
* ISOMETRIC only, but **caution long holds → may inc intra-articular pressure**
* Dynamic ex's w/ resolution of inflamm.
* Bikes, yoga, pilates, aquatics, developmental play, aerobic acts for CV endurance
54
Functional Mobility **GOAL** for JIA
**Get children _walking again ASAP_!!!**
55
Functional Mobility and JIA
* **Wt bearing/ambulation→** CRUCIAL for **bone growth, jt health, mm development**
* **Goal→** get children walking again ASAP!!!
* maybe aides/orthotics initially
* most do not req. AD but may use AD for long dist's bc **flare-ups**
56
Self-Care
## Footnote
**Modifications for children:**
* Adaptations for grip strength defs
* Adapted toys/utensils/writing tools
* replace door knobs/faucets, velcro on shoes, button hooks/zippers
* Home→ ramps, HRs for tub, raised toilet seat
57
Children w/ JIA undergo Sx procedures for **improvement in jt deformity**
## Footnote
**3 Types Sx:**
1. Soft tissue lengthening
2. Synovectomy
3. TJA (Total Jt Arthroplasty)
58
Pre-Op PT for JIA:
Improve **strength,** maintain **range**
59
Post-Op PT for JIA:
Return to **PLOF!!!**
60
School Considerations for JIA Children
* Tardiness due to **morning stiffness,** Freq. absence 2\* **systemic issues or f/u appts**
* Incd time for hygiene or getting to class, aide for note taking, untimed tests, mods for gym class
* **All leads to decd social interactions and feelings of isolation\*\*\***
61
Recreational Activities:
* Stay active and social!
* **Swimming/water** or LOW impact aerobics, cycling, yoga→ **great acts to promote!**
* \*NOTE: **_AVOID_ high impact or contact → more inflammatory**
