Juvenile Idiopathic Arthritis

Question 1

What is JIA?

Answer 1

Onset before 16yrs - most common between 1-6yrs - unknown origin

Persistent joint swelling or painful restriction of movement lasting at least 6wks

Question 2

What is oligoarticular JIA?

Answer 2

Most common JIA

Presentation:
Swelling
Morning joint stiffness 
Loss of range of movement 
Pain 
Joint deformity 
Warmth or colour change
<4 joints affected in first 6 months of disease
Mostly the knees, ankles and small joints of the hands (also feet, wrist and elbow)

May also develop chronic anterior uveitis:
Eye inflammation, often asymptomatic but detectable on slit lamp, more common in girls

Often goes away without lasting joint damage

Question 3

What is polyarticular JIA?

Answer 3

Presents in the same way as oligo but affects >5 joints in first 6m of disease

Sudden onset (may be systemically unwell e.g. fever)

Question 4

What is systemic onset JIA?

Answer 4

Also known as Still’s disease

Arthritis like oligo/poly but initially with full blown systemic symptoms:
High fever
Salmon pink rash that comes and goes with the fever
Cervical lymphadenopathy

Slower onset over a few months

Question 5

How do you diagnose JIA?

Answer 5

Clinical picture including age

USS/MRI can be useful to identify swelling hard to spot clinically e.g. in the spine, shoulder, hip and jaw

Bloods:
ESR, CRP - raised
ANA - may be positive or negative
Rheumatoid factor may be present or absent

Chalmydia/gonorrhoea swabs/bloods - to rule out reactive arthritis

Question 6

How do you manage JIA?

Answer 6

Physical therapy 
NSAIDS
Intraarticular steroids 
Methotrexate 
Etanercept (anti TNF)
Surgery

MDT - PT/OT, psychT, ophthalmology (because uveitis), rheumatology, surgery…