juvenile rheumatoid arthritis

1. ‫ا‬ ‫بسم‬‫ا‬ ‫بسم‬
‫الرحمن‬‫الرحمن‬
‫الرحيمئ‬‫الرحيمئ‬

4. Juvenile chronic arthritisJuvenile chronic arthritis
 The commonest cause of chronic arthritis inThe commonest cause of chronic arthritis in
childhoodchildhood
 chronic joint inflammation in children, with orchronic joint inflammation in children, with or
without extra-articular involvement.without extra-articular involvement.
 The mean age of onset is 1-3 yearsThe mean age of onset is 1-3 years

5.  most commonly occurs inmost commonly occurs in
females, with two exceptions:females, with two exceptions:
Males are equally likely to haveMales are equally likely to have
systemic-onset JRA.systemic-onset JRA.
Males are much more likely to haveMales are much more likely to have
late-onset pauciarticular JRAlate-onset pauciarticular JRA
(male-to-female ratio is (10:1).(male-to-female ratio is (10:1).

6. ClassificationClassification
Pauciarticular PolyarticularPauciarticular Polyarticular
50% 35%50% 35%
Systemic onsetSystemic onset
15%15%

7. Pauciarticular arthritis type IPauciarticular arthritis type I
(40%):(40%):
Few large joints affectedFew large joints affected
Common in femalesCommon in females
Chronic iridocyclitisChronic iridocyclitis
Antinuclear antibody +veAntinuclear antibody +ve
Prognosis is goodPrognosis is good

8. Pauciarticular arthritis type II:Pauciarticular arthritis type II:
10%10%
 Few large jointsFew large joints
 Mainly affects malesMainly affects males
 SacroilitisSacroilitis
 Antinuclear antibody –veAntinuclear antibody –ve
 HLA B27 +veHLA B27 +ve
 Prognosis goodPrognosis good

9. Polyarticular-RheumatoidPolyarticular-Rheumatoid
factor -ve: 25%factor -ve: 25%
 Polyarticular of small and large joints.Polyarticular of small and large joints.
 Mainly affect femalesMainly affect females
 ANA +veANA +ve
 Rheumatoid factor –veRheumatoid factor –ve
 Prognosis goodPrognosis good

10. Polyarticular-Polyarticular-
Rheumatoid factor +ve:Rheumatoid factor +ve:
10%10%
 Mainly affect femaleMainly affect female
 Above the age of 8 yearsAbove the age of 8 years
 ANA +veANA +ve
 Rheumatoid factor +veRheumatoid factor +ve
 Prognosis poor.Prognosis poor.

11. Systemic onset disease:15%Systemic onset disease:15%
(Still’s disease(Still’s disease((
 Affects male and femaleAffects male and female
 Small and large jointsSmall and large joints
 Systemic manifestations: intermittentSystemic manifestations: intermittent
fever, maculopapular rash,fever, maculopapular rash,
hepatosplenomegaly,hepatosplenomegaly,
lymphadenopathy, myocarditis,lymphadenopathy, myocarditis,
pericarditis.pericarditis.
 ANA +veANA +ve
 Rh factor -veRh factor -ve
 Cure rate 75%Cure rate 75%

12. Laboratory findingsLaboratory findings
 Anemia microcytic and hypochromic,Anemia microcytic and hypochromic,
 Acute-phase reactants are elevated, includingAcute-phase reactants are elevated, including
ESR, CRP, and platelet count.ESR, CRP, and platelet count.
 Synovial fluid aspirate: WBCs= 5000-25000/ulSynovial fluid aspirate: WBCs= 5000-25000/ul

13. Rheumatoid markersRheumatoid markers
 RFRF is negative in the majority ofis negative in the majority of
patients with JRA.patients with JRA.
 ANAANA isis present inpresent in
early-onset pauciarticular JRAearly-onset pauciarticular JRA
polyarticular JRA.polyarticular JRA.
Negative:Negative: systemic-onset JRA andsystemic-onset JRA and
late-onset pauciarticular disease.late-onset pauciarticular disease.

15. DiagnosisDiagnosis
 OnsetOnset << 16 years of age16 years of age
 ≥≥ 1 joint defined as:1 joint defined as:
 Swelling or effusionSwelling or effusion
 Limitation of movement, tenderness,Limitation of movement, tenderness,
increased warmthincreased warmth
 > 6 weeks> 6 weeks
 Exclusion of other causes of arthritis.Exclusion of other causes of arthritis.

16. ManagementManagement
 Control of inflammationControl of inflammation
a.a.Nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs
(NSAIDs) ease pain and inflammation.(NSAIDs) ease pain and inflammation.
b.Immunomodulatory medications (e.g.,b.Immunomodulatory medications (e.g.,
glucocorticoids, methotrexate,glucocorticoids, methotrexate,
sulfasalazine, hydroxychloroquine) aresulfasalazine, hydroxychloroquine) are
commonly used for more severe symptoms.commonly used for more severe symptoms.

17. Mechanical and physicalMechanical and physical
measuresmeasures::
 include physical and occupationalinclude physical and occupational
therapy, as well as selective splintingtherapy, as well as selective splinting
to minimize joint contractures.to minimize joint contractures.

18.  Surgery is generally reserved forSurgery is generally reserved for
patients who have recalcitrant jointpatients who have recalcitrant joint
contractures or destruction.contractures or destruction.
 Psychosocial supportPsychosocial support

19. Prognosis in rheumatoidPrognosis in rheumatoid
arthritisarthritis