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Flashcards in RHEUMATIC DISORDERS Deck (22):
1

What do we call arthritis that occurs in someone under the age of 16?

Juvenile idiopathic arthritis

2

What is the prevalence of juvenile idiopathic arthritis?

1 in 1000 children

3

What are the main 3 types of juvenile idiopathic arthritis?

Systemic (previously called Still's disease)

Polyarticular

Oligoarticular

4

What age group is most commonly affected by systemic juvenile idiopathic arthritis?

Under 5 year olds

5

Which joints are primarily affected in systemic juvenile idiopathic arthritis?

Both knees, wrists, ankles and tarsal bones.

6

What are the clinical features of systemic juvenile idiopathic arthritis?

Pain in several joints including both knees, wrists, ankles and tarsal bones

High daily spiking fever

Salmon-pink rash

Lymphadenopathy

Hepatosplenomegaly

Malaise and myalgia

Inflammation of pleura and serosal membranes

7

What are the subdivisions of polyarticular juvenile idiopathic arthritis?

Rheumatoid factor negative

Rheumatoid factor positive

8

How many joints must be affected for juvenile idiopathic arthritis to be classified as polyarticular rather than oligoarticular?

More than 4

9

Is the arthritis in polyarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

Symmetrical

10

What age group is most commonly affected by rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

All ages are affected

11

Which joints are primary affected in rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

All joints can be affected.

There is particular limitation in the motion of the neck and temporomandibular joint.

12

What age group is most commonly affected by rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Girls over the age of 8

13

Which joints are primary affected in rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Arthritis of the small joints of hands and feet

Hip and knee joints affected early

14

What are the extra-articular features of rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

Rheumatoid nodules on pressure points

Systemic vasculitis

15

How many joints are affected in oligoarticular juvenile idiopathic arthritis?

4 or less

16

Which joints are primarily affected by oligoarticular juvenile idiopathic arthritis?

Knees

Ankles

Elbows


Hips tend to be spared

17

What age group is most commonly affected by oligoarticular juvenile idiopathic arthritis?

Girls under 6 years old

18

Is the arthritis in oligoarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

Asymmetrical

19

What is typically found on an antibody screen of a child with oligoarticular juvenile idiopathic arthritis?

ANA

20

What are the extra-articular features of oligoarticular juvenile idiopathic arthritis?

Iridocyclitis (inflammation of the iris and ciliary body)

Anterior uveitis

21

What investigations should be done in a child that presents with signs and symptoms consistent with juvenile idiopathic arthritis?

FBC - anaemia occurs in systemic disease

Acute-phase reactants - raised

RF - negative in majority of cases

ANA - oligoarticular

X-ray

22

How do we manage a child with juvenile idiopathic arthritis?

MDT approach

Physiotherapy - optimize joint mobility, prevent deformity and increase muscle strength

Medication:

Oligo: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor.

Poly: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor and then further escalated using another TNF-alpha inhibitor

Systemic: Systemic steroids with escalation to interleukin-1 receptor antagonists