JUVENILE RHEUMATID ARTHRITIS

• JUVENILE RHEUMATID ARTHRITIS


  refers to chronic childhood arthritis.
• JUVENILE RHEUMATID ARTHRITIS


  A group of heterogeneous chronic autoimmune diseases, JIA causes inflammation in the synovium, joints, and surrounding tissue
• Clinical Manifestation

  , stiffness, swelling, and loss of motion develop in the affected joints.
• Clinical Manifestation


  Affected joints may be: warm and tender to touch, but it is not uncommon for pain not to be reported.
• Clinical Manifestation

  The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture.
• Clinical Manifestation

  Morning stiffness of the joint(s) is characteristic and resent on arising in the morning or after inactivity.
• Clinical Manifestation

  In severe, long-standing cases – growth is significantly restricted.
• • Features that distinguish JIA from adult disease include:


  Onset before 16 years of age

  A negative rheumatoid factor

  Classic symptoms of systemic arthritis, including:

  • Quotidian fever
  • Rash
  • Pericarditis
• Leukocytosis


  frequently present during flares of systemic disease.
• JIA CRITERIA for Diagnosis:

  Onset before 16 years

  Arthritis in one or more joints for 6 weeks or longer

  Exclusion of other causes
• Therapeutic Management

  Nonsteroidal anti-inflammatory drugs (NSAIDs)

  Disease modifying antirheumatic drugs (DMARDs)

  Glucocorticoids
• Physical Management:

  to reach the ultimate goal of preserving function and preventing deformity
• Physical Therapies:

  directed toward specific joints and focuses on strengthening muscles, mobilizing restricted joints, and preventing or correcting deformities.
• Occupational therapists

  assume responsibility of evaluation and improving performance of activities of daily living
• Physical Management:

  Muscle strength is frequently lost around the involved joints, and inactivity leads to generalized weakness.
• Exercising in a pool


  Is excellent because it allows freedom of movement with support.
• Physical Management:

  When joints are inflamed, heavy resistance aggravates the pain. At such times, simple isometric or tensing exercises that do not involve joint movement are generally tolerated.
• Range-of-motion exercises


  an important aspect of therapy and are continued after evidence of disease has disappeared in order to detect any signs of recurrence
• Vigilance 


  is required to detect loss of motion, and vigorous attention must be given to specialized passive stretching, positioning, and resting splints to prevent deformity.
• Synovectomy


  used primarily in pauciarticular disease when all other therapy has been unsuccessful.
• Surgery:

  intraarticular steroid injection

  Is an alternative to synovectomy and may be tried once or twice before surgery is performed
• Surgery:

  Joint Replacement

  proving to be successful in older children who are fully grown
• Nursing Care management:

  Assessment of their general health

  The status of involved joints

  Emotional responses to all of the ramifications of the disease:

  1. Pain
  2. Physical restrictions
  3. Therapies
  4. Self-concept
• Nursing Care Management:


  The effects of the disease are manifested in every aspect of the child’s life, including physical activities, social experiences, and personality development.