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Juvenile Idiopathic Arthritis

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JIA - classification, clinical features, and management

Publicada em: Saúde e medicina
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Juvenile Idiopathic Arthritis

  1. 1. Juvenile Arthritis 1
  2. 2. JIA • Commonest cause of chronic arthritis in childhood. • Onset of arthritis before 16th birthday which lasts for atleast 6 weeks and has no known cause. • Prevalence 1 to 4 per 1000 children. 2
  3. 3. JA classification (Old) ACR criteria : • Juvenile arthritis is called as Juvenile Rheumatoid Arthritis(JRA) • Duration > 6 wks • Types : Systemic onset Oligoarticular(<= 4joints) Polyarticular(>4 joints) 3
  4. 4. JA classification (Old) EULAR criteria : • Juvenile arthritis is called as Juvenile Chronic Arthritis(JCA) • Duration > 12 wks • Also included Spondyloarthropathy(jA S, jPs A, IBD associated) • RA factor positive polyarticular arthritis was called as JRA • Types : Systemic onset Oligoarticular Polyarticular Juvenile Ankylosing Spondylitis Juvenile Psoriatic Arthritis Arthritis associated with IBDs 4
  5. 5. ILAR classification • Juvenile arthritis is called as Juvenile Idiopathic Arthritis(JIA) • Duration > 6 wks • Most widely used classification worldwide • Types : Systemic onset Oligoarticular Polyarticular, RF +ve Polyarticular, RF –ve Psoriatic Arthritis Enthesitis Related Arthritis Undifferentiated Arthritis 5
  6. 6. ILAR classification types Systemic Arthritis • Quotidian fever for atleast 2 weeks • Evanescent non fixed erythematous rash • Arthritis • In the absence of arthritis, presence of fever and rash plus any two of Generalised lymphadenopathy Hepatosplenomegaly Serositis 6
  7. 7. ILAR classification types Polyarticular RF –ve : • Arthritis >5 joints during first 6 months Polyarticular RF +ve : • Arthritis >5 joints during first 6 months with positive RF on at least 2 occasions 12 weeks apart. Oligoarticular : • Arthritis 1-4 joints during first 6 months Extended Oligoarticular : • Affecting more than 4 joints after 6 months of disease 7
  8. 8. ILAR classification types Enthesitis Related Arthritis : • Arthritis and Enthesitis or • Arthritis with at least 2 of, Sacroiliac joint tenderness Inflammatory spinal pain HLA B27, onset of arthritis in a male over 6 years of age Anterior uveitis Family history of anterior uveitis/ Spondyloarthropathy/ IBD 8
  9. 9. ILAR classification types Psoriatic Arthritis : • Psoriasis and Arthritis or • Arthritis and family history of psoriasis and presence of Dactylitis or Nail abnormalities (pitting, onycholysis) Undifferentiated Arthritis : • Arthritis that doesnt fits in any of the above categories or with features of two or more categories together. 9
  10. 10. Oligo ERA PA RF -ve PA RF +ve Systemic Frequency World % 30 – 60 3 -11 (36% in India - mc) 10 -30 5 - 10 10 - 15 Sex ratio F>M M>F F>M F>M F=M Uveitis 20% chronic 25% acute ant RF + ANA 60% 20% 20% HLA B27 70% Complicatio ns Blindness Leg length discrepancy Spondyloath ropathy Joint destruction Amyloidosis MAS Prognosis Good Good Fair Poor Fair 10
  11. 11. Differential Diagnosis • Infections – ARF, osteomyelitis, TB • Malignancy – Leukaemias • Other CTDs – SLE, juvenile dermatomyositis 11
  12. 12. Investigations • CBC – anaemia, leucocutosis, thrombocytosis • Elevated ESR, CRP • RA factor • ANA – presents of ANA increases the risk of chronic uveitis and warrants 3 monthly eye checkup. • Elevated ferritin and low fibrinogen – MAS • Elevated ASO titre can be seen 20-25% of JIA patients. 12
  13. 13. Investigations • Radiographs – r/o other causes • High resolution USG and MRI – early detection of synovitis and erosions • Synovial fluid analysis and Biopsy – in persistent monoarthritis to exclude chronic infection 13
  14. 14. Treatment Physical and occupational therapy : • Splints, exercises, modified footwear Medical therapy : • NSAIDs • DMARDs – HCQs, Methotrexate, Sulfasalzine • Steroids – Oral, IV, intraarticular • Biologicals – TNF antagonists 14
  15. 15. Treatment of Enthesitis Related JIA • Mild disease - < 4 peripheral joint involvement without critical joint like hip joint - NSAIDs and intraarticular steroids • Severe disease – hip joint involvement - Methotrexate - Sulfasalazine - TNF blockers – if no improvement in 3 months. • Acute uveitis – Topical steroids 15
  16. 16. THANK YOU 16

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