Juvenile Idiopathic Arthritis

Question 1

What is juvenile idiopathic arthritis?

Answer 1

• systemic inflammatory disorders, < 16 yrs
• autoimmune disease
• most common rheumatic disease in children
• cause of disability + blindness

Question 2

What is the prevalence of juvenile idiopathic arthritis?

Answer 2

• 1/1000

Question 3

What is the diagnostic criteria for juvenile idiopathic arthritis?

Answer 3

• age of onset < 16 years
• duration > 6 weeks
• arthritis
• joint swelling OR 2 of; painful/limited joint motion, tenderness, warmth

Question 4

What are the 3 major subtypes of juvenile idiopathic arthritis?

Answer 4

• pauciarticular (4 joints or less) (55%)
• polyarticular (5 joints or more) (25%)
• systemic onset (Still’s disease) (20%)

Question 5

What are the features of pauciarticular juvenile idiopathic arthritis- type 1?

Answer 5

• limp (rather than pain)
• knee > ankle > hand/elbow (hipe rare)
• chronic uveitis (20%)
• irregular iris
• 1-3 yrs
• F:M = 3:1
• +ve ANA in 40-75%

Question 6

What are the features of pauciarticular juvenile idiopathic arthritis- type II?

Answer 6

• constitutional rare, limp
• knee, ankle, (hips can be affected)
• acute iridocyclitis (10-20%)
• > 8/9 yrs
• F:M = 1:7

Question 7

What are the features of paucarticular juvenile idiopathic arthritis- type III?

Answer 7

• constitutional rare
• asymmetric arthritis (destructive)
• dactylitis
• psoriasis
• nail pitting
• chronic iridocylitis
• childhood
• F:M = 4:1

Question 8

What are the features of polyarticular juvenile idiopathic arthritis- RF -ve?

Answer 8

• constitutional manifestations (low grade fever, malaise)
• hepatosplenomegaly
• mild anaemia
• growth abnormalites
• symmetric, large + small joints (knees, wrists, ankles, MCPs, PIPs, neck)
• often early age
• F:M = 9:1

Question 9

What are the features of polyarticular juvenile idiopathic arthritis RF +ve?

Answer 9

• constitutional manifestations (low grade fever, malaise, weight loss)
• anaemia
• nodules
• complications by; Sjogrens, Felty or vasculitis, AR, pulmonary fibrosis, AAS, CTS
• erosions on XR, early
• 12-16 yrs
• F:M = 7:1

Question 10

What are the features of systemic onset juvenile idiopathic arthritis (Still’s disease)?

Answer 10

• pyrexia (39.5ºC) daily, for 2 weeks min.
• inc. in evening, dec. in morning
• appears toxic, may have chills
• 90% fading salmon red eruption, trunk + thighs
• can be brought on by scratching (+ve Koebner’s phenomenom)
• 50-75% generalised non-tender lymphadenopathy
• 75% arthritis of; wrists, knees, ankles, cervical spine, hips, TMJ (within 3-12 months)
• hepatosplenomegaly, 50-75% abdominal pain, transaminases
• polyserositis, 36% pericarditis
• rare; tamponade, myocaditis, pleural effusion, pulmonary fibrosis
• 4-6 yrs
• F:M = 1.5:1

Question 11

What is the treatments for uveitis?

Answer 11

• steroids
• mydriatic + cycloplegic agents
• methotrexate
• mycophenolate mofetil (MMF)
• cyclosporin
• anti-TNF

Question 12

What is the treatment for juvenile idiopathic arthritis?

Answer 12

• simple painkillers
• NSAIDs
• joint steroid injections
• methotrexate
• anti-TNF
• IL-1 R-antagonist (Anakinra)
• IL-6 antagonist (Tocilizumab)
• systemic steroids
• risk of osteoperosis, infections, growth abnormalities
• topical steroids
• physiotherapy + OT
• synovectomy
• reconstructive/joint replacement surgery

Question 13

What are localised growth failures in juvenile systemic arthritis?

Answer 13

• leg length discrepancies
• shortening of; fingers, hands, forearms, toes, feet
• micrognathia

Question 14

What are generalised growth failures in juvenile idiopathic arthritis?

Answer 14

• short stature
• delayed puberty

* systemic steroids