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Paedriatrics > Rheumatology/JIA > Flashcards

Rheumatology/JIA Flashcards

1
Q

How might JIA present?

A 
Arthritis for at least 6wks
Morning stiffness
Irritability/refusal to walk (toddlers)
School absence/limited ability for physical activity
Rash/fever
Fatigue
Poor appetite/wgt loss
Delayed puberty
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2
Q

What are differentials for JIA?

A 
Septic arthritis
Osteomyelitis
Transient synovitis
Malignancy
Recurrent haemarthrosis
Vascular abnormalities
Trauma
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3
Q

What are particular signs of JIA?

A 
Swelling
Tenosynovitis
Pain
Joint held in pos. max comfort
Range of motion limited at extremes
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4
Q

What is the classification system for JIA?

A

ILAR classification

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5
Q

What age are females most likely to present with JIA?

A

1-5yrs

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6
Q

What age are males most likely to present with JIA?

A

> 8yrs

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7
Q

What are the 3 patterns of onset of JIA?

A
  1. Oligoarthritic/pauciarticular: (4 or fewer joints)
  2. Polyarticular (Occasionally 9 joints)
  3. Systemic (Large joints, no symmetry)
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8
Q

What is common in children with late onset?

A
  1. Test negative for ANA
  2. No extra articular manifestation
  3. Hip involvement
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9
Q

What is common in children with early onset?

A
  1. Uveitis
  2. Test positive for ANA
  3. Joints: knees, ankles, hands, feet, wrists
  4. No hip involvement
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10
Q

When is it polyarticular JIA?

A
  1. 5+ joints

2. Few or no systemic manifestations of disease

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11
Q

Enthesitis-related JA should have two of what six red flags?

A 
Onset of polyarthritis/oligoarthritis in boy >8 years of age
HLA B27 positivity
Acute anterior uveitis
Inflammatory spinal pain
Sacroiliac joint tenderness
FHx of enthesitis-related JIA
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12
Q

Psoriatic JIA should have any two of which three red flags?

A

Dactylitis: finger or toe inflammation
Onycholysis: nail pitting
FHx psoriasis

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13
Q

What are the signs/symptoms of systemic JIA?

A 
Unwell
Arthritis
Intermittent fever >2wks
Salmon pink erythematous rash
Generalised lymphadenopathy
Serositis
Hepatomegaly/splenomegaly
High inflammatory markers
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14
Q

Which age group is seronegative (RF negative) more common in?

A

<5

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15
Q

Which age group is seronegative (RF negative) more common in?

A

<5yrs

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16
Q

What are the screening questions in the pGALS MSK screen?

A 
Do you (or your child) have any pain or stiffness in their joints, muscles or back?
Do you (or your child) have any difficulty getting themselves dressed without any help?
Do you (or your child) have any problem going up and down stairs?
17
Q

What investigations would you do for JIA?

A

Labs
Plain XR
US
MRI with contrast

18
Q

What is the medical treatment for JIA?

A

NSAIDs
DMARDs
Biologic agents
Intra-articular and oral steroids

19
Q

What are the treatment options for JIA?

A 
Pharmacological management
Counselling
School/life adjustments
Nutrition (anaemia and osteoporosis)
Physical therapy
OT
20
Q

How long after intra articular steroids is remission usually?

A

> 6mo

21
Q

What type of JIA are intra-articular steroids most effective?

A

Oligoarticular JIA

22
Q

What is the DMARD of choice in JIA?

A

Methotrexate

23
Q

When should biological agents be used in JIA?

A

Failure to respond to DMARDs

24
Q

What are common biological agents used in JIA?

A

Anti-TNF agents

25
Q

What is a common condition associated with JIA?

A

Uveitis

26
Q

What can untreated uveitis lead to?

A

Chronic uveitis

27
Q

What JIA is uveitis more common in?

A

ANA positive oligo JIA

28
Q

What are symptoms of uveitis?

A

Red eyes
Headache
Reduced vision

29
Q

What are complications of uveitis?

A

Cataracts
Glaucoma
Blindness

30
Q

What is the treatment for uveitis?

A

Topical steroids
Systemic steroids
DMARDs and biological (if poor response to steroids)s

31
Q

What are complications of JIA?

A 
Poor growth
Localised growth disturbances
Micrognathia
Contractures
Ocular complications
32
Q

What is micrognathia?

A

Lower jaw undersized

Paedriatrics (19 decks)

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