Juvenile Idiopathic Arthritis
Juvenile Idiopathic ArthritisInternational league against rheumatism(ILAR )Classification of Juvenile Idiopathic ArthritisOligo-arthritis :Persisting arthritis : of 1 – 4 joints in first 6 months of the disease Extending arthritis : restricted to 1 – 4 joints in first 6 months that subsequently develops into polyarthritis Young
Young
Classification of Juvenile Idiopathic Arthritis2)Polyarthritis Rh –ve arthritis of >4 joints in first 6 months Rh + ve arthritis restricted to 1 -4 joints in first 6 months + positive serum Rh test 3 months apart3)Psoriatic arthritis Arthritis + psoriasis or arthritis + family history of psoriasis and either dactilylitis or nail pitting as onycholysis Young
Older-adolescent
Older girls and boys equallyClassification of Juvenile Idiopathic Arthritis
4)Enthesitis – related arthritis :Arthritis + enthesitis or Arthritis + 2 of :SI j. tenderness, inflammatory spinal pain , HLA B27 , anterior uveitis , family history of uveitis , spondarthritis or IBD5) systemic arthritis :Arthritis + fever >2 weeks , evanescent skin rash 6) Other arthritis Patients who fit no category or more than one category older boysUnder 2 yrs f= m
Oligoarthritis
Most common form targeting lower limb joint , mainly knee joint , prognosis is excellent , 30 % progress to severe polyarthritisANA an HLA – DR 5 are presented in 50 % and those children at high risk of asymptomatic chronic anterior uveitis
Polyarthritis
30 -40 % of JIP , 90 % seronegative for Rf , it is commonly affect the cervical spine , this lead to early cervical fusion and under – development of the mandible which give stiff neck , receding chin and dental problems . The prognosis is less favorable than oligoarthritis , 2/3 have residual problems into adult life and 10 % have severe joint damagePolyarthritis
10 % Rh +ve , occur in older (>8) girl, follow an aggressive coarse with erosion , joint damage , nodules and vasculitis and showed high association with HLA DR4Psoriatic arthritis
Presence of skin plaquesEnthesitis related arthritis Affect older children especially boys75 % are HLA – B27 positivethe prognosis is worse than for adultSystemic arthritis
It is least common , equally affect male and female Mostly < 2 year Lymphadenopathy , hepatosplenomegally , pleuri- pericarditis and high fever Intermittent fever with evanescent faint pink macular rash are helpful for diagnosisPrognosis
Remission within 6 months Half cases had recurrent episodes 30 % develop chronic polyarthritis and lead to secondary amyloidosisComplication
Uveitis : is asymptomatic and potentially blinding , often bilateral , detected by slit lamp , greatest risk with early onset ( <6 years ) oligoarthritis in young girls who ANA +ve Growth disturbance accelerated or retarded epiphyseal growth ( long leg or short limbs and fingers ) or early fusion of epiphyses ( short limbs , micrognathia ) Loss of schooling and family disruptionManagement
EducationRegular exercisePhysical therapy , to reduce deformities and maintain muscle strength , avoid development of flexion deformities especially hip and kneesDrug therapyNSAIDs : as naproxin , ibuprofen , tolmetin , and piroxicam avoid aspirin because of risk of Rey’s syndrome