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Arthrithis
Introduction
https://www.youtube.com/watch?v=EEcstaUcXX4
Definition
Juvenile Idiopathic Arthritis (JIA)
Most common chronic rheumatic disease of childhood.
A type of arthritis that causes joint inflammation and stiffness for more than six weeks in a
child aged 16 or younger. It includes groups of diseases that share specific characteristics.
Polyarticular JRA:
affects 5 or more joints
Arthritis present for at least 6 weeks before diagnosis (mandatory for diagnosis of
JIA)
Either insidious or abrupt disease onset, often with morning stiffness or gelling
phenomenon and arthralgia during the day
Complaints of joint pain or abnormal joint use and may have a history of school
absences or limited ability to participate in physical education classes
Spiking fevers occurring once or twice each day at about the same time of day
Generalized myalgia
Spiking Fever
Hepatospelomegaly
Generalised Rash
9
Polyarticular JIA
Physical
Characteristics:
Involvement >4
joints
Small joints
Symmetric/Asymm
etric
10
Radiograph of Hands
11
Radiograph of Chest
Hepatosplenomegaly is
often present
Lymphadenopathy is
sometimes present,
especially the axillary
lymph nodes
Muscle tenderness to
palpation may be
observed
Child with pericardial effusion due
Serositis, including pleural to systemic onset juvenile
idiopathic arthritis
and pericardial effusions, 12
may be present
Oligoarticular JIA
Physical Characteristics :
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Oligoarticular JIA
Muscle atrophy, often of extensor
muscles
15
Oligoarticular JIA
Asymptomatic
16
Oligoarticular JIA - Radiograph of
knees
17
Juvenile psoriatic arthritis
Physical
Characteristics:
Joints: Arthralgia .
Affects especially
distal Interphalangeal
joints
Skin: Plaques
Nails: Pitting
18
Workup and Diagnosis
History and clinical examination
Laboratory evaluation
Acute phase reactants
ANA/Rheumatoid factor
Fluid analysis
Imaging
Radiographs
MRI/ CT/USG
19
Diagnosis
Lab Invest:
Inflammatory markers: Erythrocyte sedimentation rate (ESR) or CRP level (elevated) can be used to monitor disease progression, complement
Complete blood count (CBC) and metabolic panel: throbocytosis, leukocytosis, Lymphopenia (emigration of activated lymphocytes out of the circulation into
synovium)
Liver function tests and assessment of renal function with serum creatinine levels
A complete blood count, liver function tests (to exclude the possibility of viral or autoimmune hepatitis), and assessment of renal function with serum
creatinine levels should be
done before starting treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), methotrexate (MTX), or tumor necrosis factoralpha inhibitors
Antinuclear antibody (ANA) testing: increased risk of anterior uveitis
Rheumatoid factor (RF) and anticyclic citrullinated peptide (CCP) antibody
Additional studies: Total protein, albumin, fibrinogen, ferritin, D-dimer, angiotensin-converting enzyme (ACE), antistreptolysin 0 (AS0), anti-DNAse B,
urinalysis
When only a single joint is affected, radiography is important to exclude other diseases.
Occupational therapy
Coordinated care
Pediatric rheumatologist
Opthalmology consultations
22
Surgical management
Need for surgical therapy may be
decreasing as a result of improved medical
management
Arthroplasty
23
Complications
Growth retardation and osteopenia
24
TMJ involvement with growth
failure of lower jaw
25
Other Complications
Localised growth disturbances
Sexual maturation, sleep disturbance and fatigue
Macrophage activation syndrome
Amylodosis
Drugs related side effects
26
Prognosis
Common misconception - childhood
arthritis would disappear in
adulthood