Juvenile Idiopathic Arthritis

Rheumatology and Orthopedics

Dr. Brian Alverson

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Case Study

Child
Several rounds of
11-year-old
antibiotics

Long-standing pain

Swelling in fingers, wrists

and ankles

What is the most likely diagnosis?

Lissauer & Clayden,

NailahIllustrated
Rahmah, Textbook of Paediatrics, 4th Edition, 2011, p. 462, Mosby (Elsevier)
nailahrahmah1997@gmail.com
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 JIA
Pathology

• In general, causes pain and swelling

in joints

• Autoimmune disease

• Typical onset is before 16 years.

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Several Very Different Types of JIA
Pathology

Oligoarticular JIA Polyarticular JIA Systemic JIA

Also: Enthesitis-associated, psoriatic, undifferentiated

Nailah Rahmah, nailahrahmah1997@gmail.com

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 JIA Characteristics
Pathology

• Synovium is target organ for inflammation.

• Results in proliferation of synovial tissue,

increased joint fluid

• Increased blood flow, swelling,

inflammatory cells in joint

Pediatrics
Nailah Rahmah, nailahrahmah1997@gmail.com p. 161, Saunders (Elsevier)
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 Progression of Symptoms
Pathology

Bone, tendon,
Persistent Joint ligament
synovitis destruction destruction

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Types of JIA
Clinical Presentation

Oligoarticular Polyarticular Systemic

% of JIA cases 50 % 35 % 10 %

Gender F>M F>M F=M

Age 2 3 y, rare > 10 y 2 5 y, 10 14 y Any < 17 y

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Types of JIA
Clinical Presentation

Oligoarticular Polyarticular Systemic

# joints affected <5 Any
Type of joints • Medium and • Any • Any
affected large joints • Usually • Destructive
• Asymmetric symmetric arthritis High-yield
• Rarely in hips • Rarely in hips
• Nondestructive • Destructive
arthritis arthritis

Systemic Asymptomatic Less frequent uveitis Daily high fevers,

features 20 % uveitis Evanescent salmon-
(if ANA+) pink rash, HSM, LAD,
Heart/lung/liver

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Chronic Destruction of Knee Joints
Clinical Presentation

Lissauer & Clayden,

NailahIllustrated
Rahmah, Textbook of Paediatrics, 4th Edition, 2011, p. 462, Mosby (Elsevier)
nailahrahmah1997@gmail.com
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 Historical Findings
Clinical Presentation

• Joint pain

• Morning stiffness, or stiffness after

inactivity for a

• Limp

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Historical Findings
Clinical Presentation

25 % report no pain,
only swelling is observed,
massage

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Salmon Rash
Clinical Presentation

High-yield

Lissauer & Clayden,

NailahIllustrated
Rahmah, Textbook of Paediatrics, 4th Edition, 2011, p. 462, Mosby (Elsevier)
nailahrahmah1997@gmail.com
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 Clinical Diagnosis
Diagnosis

Lab evidence of nonspecific inflammation:

• Elevated ESR, CRP, WBC, platelets

Rheumatoid factor:
• Bad screening test

• RF+: predicts chronic erosive joints in

polyarticular JIA

• ANA+: is associated with increased risk of uveitis.

• HLA B27+: in enthesitis associated JIA

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Imaging
Diagnosis

X-ray and MRI findings show erosive changes and inflammation.

F.l.t.r.: Teramoto A et al., https://openi.nlm.nih.gov/detailedresult.php?img=PMC3700890_1752-1947-7-166-4&query=juvenile+idiopathic+arthritis

&lic=by&req=4&npos=104,
Nailah Rahmah, CC BY 2.0, PubMed; Laurell L et al., https://openi.nlm.nih.gov/detailedresult.php?img=PMC3608365_1546-0096-10-23-
nailahrahmah1997@gmail.com
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3&query=juvenile+idiopathic+arthritis&lic=by&req=4&npos=289,
© www.lecturio.com | This document is protected CC BY 2.0, PubMed
by copyright.
 JIA
Management

• NSAIDS

• Steroids ( joint injections) High-yield

• Methotrexate
• Follow CBC and LFTs every few months for neutropenia, transaminitis

Nailah Rahmah, nailahrahmah1997@gmail.com

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 JIA
Management

Treating complications of JIA:

• Leg length discrepancy special shoes or operative

• Uveitis requires frequent ophthalmologist screening if ANA+

• Contractures physical therapy, botox injections, muscle relaxants

• Growth problems careful monitoring

Nailah Rahmah, nailahrahmah1997@gmail.com

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 Prognosis
Management

• Oligoarticular highest rate of remission

• RF+ oligoarticular lowest likelihood of

remission, persists into adulthood

• Prognosis for systemic depends on extent

of arthritis and systemic symptoms after 6
months.

Nailah Rahmah, nailahrahmah1997@gmail.com

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 This document is a property of: Nailah Rahmah

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Nailah Rahmah, nailahrahmah1997@gmail.com

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