Juvenile Idiopathic Arthritis

Question 1

3 types of JIA

Answer 1

Oligoarticular (55%)
Polyarticular (25%)
Systemic onset (20%

Question 2

What is the most commonly diagnosed Rheumatic disease in children

Answer 2

Juvenile Idiopathic Arthritis

Question 3

Describe pauciarticlar JIA

Answer 3

Most common type

4 or less joint involvement

Question 4

Describe polyarticular JIA

how many joints and what % RF +ve/-ve

Answer 4

5 or more joint involvement
15% RF -ve
10% RF +ve

Question 5

1st line Rx JIA

Answer 5

Simple pain killers

NSAIDs

Question 6

Which DMARD is used in JIA

Answer 6

Methotrexate

Question 7

Which 3 biologics are used to treat JIA

Answer 7

Anti-TNF
IL-1 R antagonist (Anakinra)
IL-6 Antagonist (Tocilizumab)

Question 8

Indications for systemic steroids in JIA

Answer 8

Systemic JIA
Serious disease complications with any of the subtypes
Children undergoing surgery
Bridge between DMARD drugs

Question 9

Side effects of steroids

Answer 9

Osteoporosis
Infections
Growth abnormalities
DM

Question 10

Describe oligoarticular JIA

Answer 10

55% of JIA

4 or less joint involvement

Question 11

Ix for JIA

Answer 11

Examine 
Thorough history 
Rule out infection 
ESR 
ASO 
RF 
ANA

Question 12

1st line rx for oligoarticular JIA

Answer 12

Simple pain killers

Question 13

What is the main line Rx in oligoarticular JIA if 1 or 2 joints is affected

Answer 13

Local steroids

Question 14

Criteria for Dx of JIA

Answer 14

<16 years 
>6 week history 
Joint swelling + 2 of following:
Painful or limited joint motion 
Tenderness
Joint swelling

Question 15

What are the two classifications for polyarticular JIA

Answer 15

RF-ve

RF +ve

Question 16

Are majority of polyarticular RF -ve or +ve

Answer 16

RF -ve

Question 17

Ix for JIA

Answer 17

O/E 
History 
ESR 
CRP 
RF 
ANA

Question 18

Rehabilitation for JIA options

Answer 18

Physio.

OT

Question 19

Surgical Rx for JIA

Answer 19

Synovectomy
Reconstructive
Joint replacement

Question 20

Symptoms of JIA

Answer 20

Young
Joint stiffness
Joint pain
Joint swelling

Question 21

Which other organ is commonly affected in JIA apart from the joints

Answer 21

Eyes

Question 22

Who does RF +ve polyarticular commonly affect

Answer 22

Girls

Older (12-16yrs)

Question 23

Who does RF -ve polyarticular commonly affect

Answer 23

Young girls

Question 24

Which eye condition is oligoarticular JIA commonly associated with

Answer 24

Uveitis

Question 25

Which joints does oligoarticular JIA typically affect

Answer 25

Large joints | E.g knee, ankle, wrist, elbow

Question 26

Which joints does polyarticular JIA typically affect

Answer 26

Typically symmetrical | Often involving small joints of the hand and feet

Question 27

Describe psoriatic JIA

Answer 27

``` Usually presents with: Arthritis FH Psoriasis (1st degree) Nail changes, and/or dactylitis; psoriatic rash may/may not be present. ```

Question 28

Who does enthesitis JIA typically affect

Answer 28

Boys 6

Question 29

Describe enthesitis JIA

Answer 29

affects boys over the age of 6 years and usually presents with asymmetrical arthritis, enthesitis, and sacro-iliac joint involvement.

Question 30

For which JIA would you tend to worry most about opthamological involvement

Answer 30

Oligoarticular

Question 31

Which is the least common JIA

Answer 31

Systemic onset

Question 32

Which is the most serious JIA

Answer 32

Systemic onset

Question 33

Describe RF and ANA generally in systemic JIA

Answer 33

RF -ve ANA -ve Generally

Question 34

Clinical features of Systemic JIA

Answer 34

Fever (characteristic) Evanescent salmon pink macular rash Lymphadenopathy Joint involvement

Question 35

Does joint involvement for systemic JIA need to be present for a diagnosis

Answer 35

No not initially

Question 36

Describe the fever in systemic JIA

Answer 36

more of a high grade fever Patterned fever Can spike at the same time everyday or twice a day with spontaneous return to baseline

Question 37

What is another name for systemic JIA

Answer 37

Stills Disease

Question 38

What internal organ involvement can occur in systemic JIA

Answer 38

``` Hepatosplenomegaly Generalised lymphadenopahty Polyserositis Pericarditis Pleural effusion ```

Question 39

When do joint manifestations of systemic JIA occur

Answer 39

Within 3-12 months of rash/fever symptoms

Question 40

Which factor is enthesitis JIA commonly relied to

Answer 40

HLA-B27

Question 41

What FH could suggest enthesitis JIA

Answer 41

Ankylosing spondylitis

Question 42

What FH would suggest psoriatic JIA

Answer 42

FH of psoriasis

Question 43

What is enthesitis

Answer 43

Pain where bone meets tendon

Question 44

What is undifferentiated JIA

Answer 44

JIA presenting with features of more than one subtype