Dr shridhar jia children and young people with arthritis

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  • Systemic form is asso with HLA DR4 Oligoarhritis HLA DR5
  • Intial Rx NSAIDS to reduce inflammation in affected joints and avoid long term damage to joints. Second choice drugs - DMARDS – slow acting - anti rheumatic drugs to induce disease remission or to sloe its evolution Steroids injected into some joints to rapidly help improvement, after first drainage off any fluid in that joint that may be restricting movement. Prednisolone – s-e – inhibtion of structural growth and premature appearance of osteoporosis

Transcript

  • 1. Children with Arthritis (JIA) Dr A Sridhar, Consultant Paediatrician, UHL NHS Trust, Leicester
  • 2. Juvenile Idiopathic Arthritis (JIA)
    • Most common connective tissue disease in childhood
    • The DOH Musculo-skeletal framework states that musculo-skeletal conditions are the biggest cause of disability in children .
    • In recent years, the management of children with Arthritis has changed significantly.
    • The availability of the new drugs (DMARDS, Biologicals) has lead to a marked improvement in disease outcomes
    • The emphasis is on early diagnosis and tight disease control
  • 3. J.I.A. R.A.
    • a disease affecting a growing developing skeleton.
    • a disease affecting a developed skeleton .
    • In children there is the capacity for regeneration, re-modelling and repair
    • This needs to be used to a maximum
    • The treatment needs to be different
  • 4. JIA- Definition
    • Is a group of conditions
    • in which there is chronic arthritis
    • lasting more than 6 weeks ,
    • presenting
    • before 16 years of age
  • 5. JIA- Criteria for Diagnosis American College of Rheumatology Revised Criteria
    • Age of onset < 16 years
    • Arthritis of one or more joints
    • Duration of disease > 6 weeks
    • Other conditions which present with arthritis in childhood must be excluded
  • 6. Aetiology
    • Autoimmune disease in which the cause of arthritis is largely unknown
    • combination of factors
      • Environment (infection, trauma, stress)
      • Immuno-genetic
  • 7. JIA Epidemiology
    • Described in all races and geographic areas
    • The UK prevalence is estimated at 1:1000 under 16 years with an incidence of approximately 1:10000
    • Females predominate 2:1
    • Leicestershire has a population of approximately 117,600 children (Mid-2006 population estimates)
  • 8. JIA- Onset Types
    • Pauciarticular ( < 4 joints)
    • Polyarticular ( > 5 joints)
    • Systemic (arthritis with fever and rash)
  • 9. ILAR Proposed Classification Criteria
    • Juvenile Idiopathic Arthritis (JIA)
    • Systemic
    • Polyarticular: RF+ and RF-
    • Oligoarticular: persistent and extended
    • Psoriatic arthritis
    • Enthesitis-related arthritis
  • 10. Presenting features of Arthritis
    • Joint Pain
    • Joint Stiffness
    • Joint swelling
    • Limp
    • Restriction of movement
    • Eye symptoms
    • Systemic symptoms
  • 11. Common Differential Diagnosis
    • Irritable hip- Transient Synovitis
    • Septic Arthritis, Osteomyelitis
    • Infection – Viral, Bacterial, Lyme disease
    • Malignancy – leukaemia, Neuroblastoma
    • Perthe’s Disease
    • Slipped Capital Femoral Epiphysis (SCFE)
  • 12. Generalised Joint and Bone pains
    • Non-specific but clinically well, No joint Swelling
    • Hyper-mobility of Joints- either Syndromic or Benign Hypermobilty syndromes
    • Vitamin D deficiency
  • 13. JIA Management
    • No cure but treatable
    • Remissions and Relapses
    • Involves multidisciplinary team (MDT) approach
    • Relieve pain, reduce inflammation, preserve joint function, maintain normal growth and development
    • Screen for Uveitis
  • 14. Medical Management
    • NSAIDS – Ibuprofen, Naproxen, Piroxicam
    • DMARDS (Disease modifying anti rheumatic drugs)
    • - under Rheumatologist’s supervision
    • - Methotrexate: Orally or subcutaneously: Weekly
    • Joint steroid injections
    • Corticosteroids : Oral or IV Methyprednisolone
    • Anti- TNF agents
    • – block the immune protein TNF : Infliximab, Etarncept, Adalimumab
  • 15. Physiotherapist & Occupational Therapists
    • Develop exercise programs
    • Strengthen muscles & keep joints flexible
    • Encourage normal limb development
    • Maintain function and prevent deformities
    • -
  • 16. JIA Prognosis
    • Chronic disease which is treatable but cannot be cured
    • Characterized by remissions and Relapses
    • Overall the prognosis is much better in JIA compared to RA
  • 17. JUVENILE RHEUMATOID ARTHRITIS Poor Prognostic Signs
    • Pauciarticular
      • Long duration of active disease
      • Conversion to polyarticular disease
      • Chronic uveitis
    • Polyarticular
      • Long duration of active disease
      • Articular erosions
      • RF positivity
    • Systemic
      • Conversion to polyarticular disease
  • 18. Paediatric Rheumatology Service Aims of the Service
    • To provide a high quality care for children and young people with Rheumatological problems locally
    • To provide or enable them to receive the care at home
  • 19. Paediatric Rheumatology Service
    • Running the service:15 yrs
    • All children < 16 yrs age
    • Children between 16-18 yrs( full time education) or with other chronic medical conditions
    • Significant number of children with JIA on Methotrexate therapy
  • 20. Clinical team
    • Consultant Paediatricians with specialist interest in Paediatric Rheumatology
    • Adult Rheumatologist
    • Specialist Registrar
    • Clinical Nurse Specialist (CNS)
  • 21. Conditions seen
    • JIA and other Inflammatory Arthropathies
    • Non-inflammatory Musculo-skeletal pain syndromes
    • Childhood Vasculitis
    • Hyper-mobility syndromes
  • 22. OPD clinics
    • OPD Clinics; New and follow up
    • Consultant/Registrar led
    • Weekly clinics
    • Rapid access clinics
    • Annual Reviews
  • 23. Children’s Day Care Unit
    • Mon-Fri, 0800- 1800 hrs
    • Methotrexate info, counselling , injections, training to parents
    • Bloods sampling
    • Joint steroid injections
    • Specialist Nurse support- Close liaison with Diana team in the community
    • Methotrexate MDT meetings:
    • ( 2 meetings/month): Specialist nurse, Pharmacist and Consultant
  • 24. Inpatient Services
    • Dedicated support by on-call team
    • Open access to Children’s assessment unit- 24x 7
    • Multi-disciplinary team: Physiotherapy, OT, other speciality input
  • 25. Support Services
    • Paediatric Physiotherapist
    • Occupational Therapist (O.T)
    • Podiatrist/Orthotist
    • Paediatric Pharmacist
    • Paediatric Dietician
    • Play therapist
    • Dedicated secretarial support
  • 26. Specialist Services
    • Paediatric Ophthalmologist
    • Paediatric Dermatologist
    • Paediatric Orthopaedic Surgeon
    • Paediatric Radiologist: X-rays, U/S, MRI Scans
    • Musculo-Skeletal Radiologist; Monthly meetings
  • 27. Transition
    • Transitional Services
  • 28.