Idiopathic/inflammatory arthritis

• What are the different types of juvenile idiopathic arthritis (JIA)?


  Systemic JIA

  Polyarticular JIA

  Oligoarticular JIA

  Enthesitis related arthritis

  Juvenile psoriatic arthritis
• What is juvenile idiopathic arthritis?

  Collective term used to describe arthritis that affects children & young individuals under 16

  Diagnosis of exclusion

  Characterised by persistent joint swelling that lasts for more than 6 weeks
• Juvenile idiopathic arthritis is the most common cause of chronic joint pain in paediatric population.
• What are the RFs of juvenile idiopathic arthritis?


  Female

  HLA polymorphism

  FHx of autoimmunity
• What is systemic JIA?


  Rare

  Associated with systemic involvement (fever, generalised malaise, salmon pink rash, lymphadenopathy, hepatosplenomegaly, pericarditis)
• What are the signs & symptoms of juvenile idiopathic arthritis?


  Joint pain lasting more than 6 weeks

  Joint swelling

  Morning stiffness

  Limited ROM

  NOTE: unlike adults, children tend to have involvement of TMJ

  Pyrexia

  Rash

  Uveitis

  Serositis affecting lungs & heart
• What are the DDx of juvenile idiopathic arthritis?


  Septic arthritis

  Malignancy (leukaemia)

  Lupus

  Reactive arthritis
• What are the Inx of juvenile idiopathic arthritis?


  Diagnosis is primarily clinical

  Obs

  Full Hx & examination

  Bloods (FBC, ESR/CRP, ANA, RF, HLA B27)

  USS/MRI of affected joints -> may reveal synovial hypertrophy, effusion or bone erosion

  Joint aspirations -> to rule out infection or malignancy
• What is the management of juvenile idiopathic arthritis?


  Physio

  Occupational therapists

  Orthopaedic specialists

  Emotional & psychological support

  Ophthalmologist -> regular eye checks

  Medical management

  • NSAIDs
  • Steroids (can be intra-articular or oral)
  • Steroid-sparing agents (methotrexate or biological agents (TNF-a inhibitors))
• What are the potential complications of juvenile idiopathic arthritis?


  Flexion contractures

  Joint destruction

  Growth failure

  Anterior uveitis

  Macrophage activation syndrome (hyperinflammation syndrome of fever, hepatosplenomegaly, encephalopathy, raised liver enzymes & high ferritin)

  Osteoporosis
• What is a common complication of idiopathic juvenile arthritis?

  Chronic anterior uveitis