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Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis
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Juvenile idiopathic arthritis

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  • 1. Juvenile Idiopathic Arthritis 1
  • 2. Definition • “Definite arthritis of unknown origin that begins before the age of 16 years and persists for at least 6 weeks” Terminology • JRA/JCA/JIA 2
  • 3. Juvenile Idiopathic Arthritis • Most common chronic rheumatic disease of childhood. • Group of related, genetically heterogeneous, phenotypically diverse immunoinflammatory disorders affecting joints and other structures. • True frequency is not known 1 to 20 per 100,000 population. 3
  • 4. Clinical Manifestations • Swelling of a joint/synovial hypertrophy • Limited range of motion • Tenderness/Warmth/redness of a joint • Gait disturbance • Fever, rash, serositis, red eyes • Anorexia, weight loss , and growth failure • Sleep disturbances, Fatigue 4
  • 5. Systemic JIA 5
  • 6. Polyarticular JIA 6
  • 7. Radiograph of Hands 7
  • 8. Oligoarticular JIA 8
  • 9. Oligoarticular JIA - Radiograph of knees 9
  • 10. Juvenile psoriatic arthritis 10
  • 11. 11
  • 12. JIA Enthesitis related arthritis 12
  • 13. JIA Subgroups JIA subtype % Age Girls% Typical Pattern HLA B27 Systemic arthritis 4-7 4-7 48-70 Any or none 4-11 Oligoarthritis 46-54 4-5 66-78 Large joints, asymmetric 11-17 RF-negative polyarthritis 13-21 4-7 76-80 Any, often symmetric 10-11 RF-positive polyarthritis 1-4 11-12 83-92 typically symmetric arthritis 8-18 Psoriatic arthritis 3-7 8-10 57-69 Spine, lower extremities, distal interphalangeal joints 8-21 Enthesitis- related arthritis 4-14 10-12 9-38 Spine, sacroiliac, lower extremities, thoracic cage joints 67-76 13
  • 14. Prognosis • Common misconception - “childhood arthritis would disappear in adulthood” • Clinical remission in 40-60% (over 10 – 28 yrs)  Systemic-onset JIA 0-50%  Oligoarthritiscular JIA 50- 80%  Polyarticular JIA 20-30%  ERA 0- 30%  PSA 30- 40% 14
  • 15. ILAR(2001) criteria - juvenile idiopathic arthritis 1. Systemic 2. Oligoarthritis a. Persistent b. Extended 3. Polyarthritis (rheumatoid factor negative) 4. Polyarthritis (rheumatoid factor positive) 5. Psoriatic arthritis 6. Enthesitis-related arthritis 7. Undifferentiated arthritis a. Fits no other category b. Fits more than one category 15
  • 16. Complications Growth retardation and osteopenia 16
  • 17. TMJ involvement with growth failure of lower jaw 17
  • 18. Sequelae of chronic uveitis 18
  • 19. Other Complications • Localised growth disturbances • Sexual maturation, sleep disturbance and fatigue • Macrophage activation syndrome • Amylodosis • Drugs related side effects 19
  • 20. Diagnosis • History and clinical examination • Laboratory evaluation – Acute phase reactants – ANA/Rheumatoid factor – Fluid analysis • Imaging – Radiographs – MRI/ CT/USG 20
  • 21. Treatment - Drugs • Steroids – intra-articular /oral • Non steroidal anti inflammatory drugs • DMARDS – Methotrexate, sulfasalazine, leflunomide, cycl osporine,thalidomide • Biologicals – TNF alpha blockers, IL-1, IL-6 blockers, costimulation inhibitors ,Rituximab, IVIg. 21
  • 22. Supportive care • Physical therapy • Occupational therapy • Psychological development and growth – Peer group relationship and schooling – Nutrition – Parent counselling • Coordinated care – Pediatric rheumatologist – Opthalmology consultations 22
  • 23. Surgical management • Need for surgical therapy may be decreasing as a result of improved medical management • Epiphysiodesis • ? Synovectomy • Soft tissue surgery • Arthroplasty 23
  • 24. Take home messages • JIA is more than just one disease • Arthritis is a clinical diagnosis • Early aggressive therapy according to subtype of JIA (uveitis). • Bone health, physical and psychological growth. 24
  • 25. Thank you 25

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