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15 Cards in this Set
- Front
- Back
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Clinical definition of arthritis
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Joint swelling/effusion OR
2 of the following: tenderness or pain on movement limited movement increased warmth |
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JIA: classification criteria
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Onset <16yo
Duration >6wks Exclusion of other causes (IMPORTANT) No diagnostic test |
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JIA: disease mimicks
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Trauma
Infection Malignancy Mechanical (overuse syndromes, avascular necrosis=Legg-Perthe's, slipped capital femoral epiphysis) Pediatric pain syndromes (growing pains, reflex sympatheic dystrophy, fibromyalgia, conversion rxn) Autoimmune diseases (SLE, dermatomyositis, vasculitis) |
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Childhood malignancies that mimick arthritis
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Systemic: Leukemia, Lymphoma. Neuroblastoma
Local: osteoid osteoma, eosinophilic granuloma, sarcoma |
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Clinical findings in malignancy
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Pain > physical findings
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Major JIA subtypes
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Systemic: fever, rash
Oligoarticular</= 4 joints Polyarticular >/= 5 joints: RF negative, RF positive Enthesitis related Psoriatic |
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Systemic JIA: extra-articular features
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Fever, rash, lymphadenopathy, hepatosplenomegaly, serositis, anemia, high inflammatory markers, groth failure
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Oligoarticular JIA: Clinical features
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< 5yo
Girls>boys Large joints, knee most common ANA positive in 80% RF negative |
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Oligoarticular JIA: complications
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Knee flexion contracture
Quadriceps atrophy Leg-length discrepency (Large joints: affected limb longer, small joints: affected limb shorter) Uveitis (20%, asymptomatic) |
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Polyarticular JIA: clinical features
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Young, girls>boys
Small and large joints, cervical spine, TMJ Uveitis (10%) ANA positive (50%) RF (usually negative) |
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RF negative polyarticular JIA: clinical features
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True juvenile rheumatoid arthritis
Older, G>B Symmetric small and large joint arthritis Rheumatoid nodules |
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Enthesitis related arthritis: clinical features
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>8yo, B>G
Family history Lower limb arthritis HLA-B27 Symptomatic uveitis |
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Psoriatic JIA: sites of hidden psoriasis
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Scalp, umbilicus, nails
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JIA: treatment goals
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Control symptoms (inflammation, pain)
Prevent damage Maximize function Full physical growth Promote psychological growth |
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JIA: Therapeutic approach
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1st line: NSAIDS+/- joint injection
2nd line: methotrexate, sulfasalazine 3rd line: TNF antagonist (etanercept) |
