Juvenile Idiopathic Arthritis
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This document discusses juvenile arthritis (JIA), the most common cause of chronic arthritis in childhood. It describes different classification systems for JIA, including the current ILAR classification which divides JIA into 7 subtypes based on symptoms. The subtypes include systemic, oligoarticular, and different types of polyarticular JIA. It also discusses investigations, treatment options including medications and physical therapy, as well as complications and prognosis for each JIA subtype.
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A Case of Idiopathic Juvenile Arthritis
A 14 year old boy presented with low grade fever, anemia, splenomegaly and polyarthritis of the left ankle, left knee and right middle finger for 6 months. Based on the findings, he was diagnosed with Juvenile Idiopathic Arthritis. Juvenile Idiopathic Arthritis is a chronic autoimmune disease characterized by arthritis in children under 16 years of age lasting more than 6 weeks, for which other causes have been excluded. Treatment involves medications like NSAIDs, DMARDs, corticosteroids and biologics to suppress inflammation and maintain function.
Approach arthritis in childhood
This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
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1. The document provides guidance on approaching a child presenting with arthritis. It defines arthritis and arthralgia and classifications based on number of joints involved.
2. It outlines the important aspects of history taking for a child with arthritis, including onset of symptoms, associated symptoms, nature of pain, and medications.
3. The key causes of acute and chronic monoarthritis are discussed, including septic arthritis, juvenile idiopathic arthritis, pigmented villonodular synovitis, and osteoarticular tuberculosis.
4. Examinations and investigations are described to differentiate between infectious, inflammatory, and malignant causes of childhood arthritis.
Approach to Arthritis in Children
This document provides guidance on evaluating a child presenting with joint inflammation or arthritis. It discusses the differential diagnosis for monoarthritis vs polyarthritis and key aspects of the history, physical exam, and initial investigations. For monoarthritis, important considerations include infection (septic arthritis, reactive arthritis), trauma, inflammation (juvenile idiopathic arthritis), and malignancy. Transient synovitis of the hip is also reviewed. A thorough history, physical exam, and joint aspiration (if indicated) are critical for diagnosis.
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Juvenile Idiopathic Arthritis
1. Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritis in children under 16 years old lasting over 6 weeks, with unknown cause thought to involve genetic and environmental factors like infection or stress.
2. JIA is classified into 7 subtypes based on symptoms and onset, including oligoarticular, polyarticular, and systemic, each with different characteristics and prognoses.
3. Treatment is individualized and aims to suppress inflammation and maintain function, using methods like medications, exercises, splints, and occasionally surgery. While remission is possible, JIA usually results in a chronic disease course with fluctuating symptoms.
A case presentation on juvenile idiopathic arthritis
This document provides an overview of juvenile idiopathic arthritis (JIA), including its etiology, pathophysiology, classification, clinical manifestations, diagnosis, complications, treatment, and follow up. JIA is the most common chronic rheumatic illness in children, characterized by synovitis and inflammation of peripheral joints. While its exact cause is unknown, it involves both genetic and environmental factors. Treatment involves a multidisciplinary approach including medications like NSAIDs, DMARDs, steroids, and biologics, as well as physiotherapy, with the goals of relieving symptoms, slowing disease progression, and preserving joint function.
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A Case of Idiopathic Juvenile Arthritis
A 14 year old boy presented with low grade fever, anemia, splenomegaly and polyarthritis of the left ankle, left knee and right middle finger for 6 months. Based on the findings, he was diagnosed with Juvenile Idiopathic Arthritis. Juvenile Idiopathic Arthritis is a chronic autoimmune disease characterized by arthritis in children under 16 years of age lasting more than 6 weeks, for which other causes have been excluded. Treatment involves medications like NSAIDs, DMARDs, corticosteroids and biologics to suppress inflammation and maintain function.
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This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
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1. The document provides guidance on approaching a child presenting with arthritis. It defines arthritis and arthralgia and classifications based on number of joints involved.
2. It outlines the important aspects of history taking for a child with arthritis, including onset of symptoms, associated symptoms, nature of pain, and medications.
3. The key causes of acute and chronic monoarthritis are discussed, including septic arthritis, juvenile idiopathic arthritis, pigmented villonodular synovitis, and osteoarticular tuberculosis.
4. Examinations and investigations are described to differentiate between infectious, inflammatory, and malignant causes of childhood arthritis.
Approach to Arthritis in Children
This document provides guidance on evaluating a child presenting with joint inflammation or arthritis. It discusses the differential diagnosis for monoarthritis vs polyarthritis and key aspects of the history, physical exam, and initial investigations. For monoarthritis, important considerations include infection (septic arthritis, reactive arthritis), trauma, inflammation (juvenile idiopathic arthritis), and malignancy. Transient synovitis of the hip is also reviewed. A thorough history, physical exam, and joint aspiration (if indicated) are critical for diagnosis.
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Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
Pediatric systemic lupus erythematosus
1. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of auto-antibodies against components of the cell nucleus.
2. SLE affects multiple organ systems and is more common in females, with a female to male ratio of 9:1 before puberty.
3. Diagnosis of SLE requires meeting 4 out of 11 American College of Rheumatology diagnostic criteria, including at least 1 clinical and 1 immunological criterion. Common clinical manifestations include malar rash, arthritis, renal disease, and hematological abnormalities.
Juvenile Idiopathic Arthritis
1. Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritis in children under 16 years old lasting over 6 weeks, with unknown cause thought to involve genetic and environmental factors like infection or stress.
2. JIA is classified into 7 subtypes based on symptoms and onset, including oligoarticular, polyarticular, and systemic, each with different characteristics and prognoses.
3. Treatment is individualized and aims to suppress inflammation and maintain function, using methods like medications, exercises, splints, and occasionally surgery. While remission is possible, JIA usually results in a chronic disease course with fluctuating symptoms.
A case presentation on juvenile idiopathic arthritis
This document provides an overview of juvenile idiopathic arthritis (JIA), including its etiology, pathophysiology, classification, clinical manifestations, diagnosis, complications, treatment, and follow up. JIA is the most common chronic rheumatic illness in children, characterized by synovitis and inflammation of peripheral joints. While its exact cause is unknown, it involves both genetic and environmental factors. Treatment involves a multidisciplinary approach including medications like NSAIDs, DMARDs, steroids, and biologics, as well as physiotherapy, with the goals of relieving symptoms, slowing disease progression, and preserving joint function.
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Lecture 1 .juvenile idiopathic arthritis
This document provides an overview of juvenile idiopathic arthritis (JIA), including its epidemiology, classifications, clinical presentations, and treatment approaches. JIA is the most common rheumatic disease in childhood, affecting about 1 in 1000 children. It encompasses a group of arthritides of unknown cause that begin before age 16. There are several subtypes of JIA classified by the ILAR system based on clinical features. Treatment involves medications like NSAIDs, corticosteroids, methotrexate, and biologics, with the goal of controlling inflammation and preventing long-term joint damage. Regular monitoring of patients on medications is important for safety.
Juvenile idiopathic arthritis (JIA)
is an umbrella term referring to a group of disorders characterized by chronic arthritis. JIA is the most common chronic rheumatic illness in children and is a significant cause of short-and long-term disability.
It is a clinical diagnosis made in a child less than16 years of age with arthritis (defined as swelling or limitation of motion of the joint accompanied by heat, pain, or tenderness) for at least 6 weeks’ duration with other identifiable causes of arthritis excluded.
pediatric Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and circulating autoantibodies directed against self-antigens. SLE predominantly affects females and can involve many organs systems, leading to a variety of clinical manifestations. Diagnosis is based on meeting 4 out of 11 criteria developed by the Systemic Lupus International Collaborating Clinics, including at least 1 clinical and 1 immunologic criteria. Treatment involves controlling symptoms, preventing organ damage, and immunosuppressive drugs such as corticosteroids and hydroxychloroquine. The course of SLE can be variable with periods of disease exacerbation and remission.
juvelnile idiopathic arthritis
A 10-year-old girl presented with pain and swelling in multiple small and large joints of both upper and lower limbs for the past 7 months. On examination, her knees, elbows, and small joints of hands and feet were swollen, warm, tender with restricted movement. Based on the symmetrical involvement of multiple joints, she was provisionally diagnosed with polyarticular juvenile idiopathic arthritis.
Approach to arhritis in children
This document discusses arthritis in children. It begins with definitions of arthritis and arthralgia and classifications of arthritis according to duration and number of joints involved. Common causes of acute, subacute, and chronic arthritis in children are described. Juvenile idiopathic arthritis is discussed in detail, including classification systems and management approaches. Specific conditions like septic arthritis, rheumatic fever, reactive arthritis, and sickle cell arthropathy are also summarized. The document concludes with a case scenario and emphasizes taking a thorough history and examination to diagnose childhood arthritis.
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- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
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Juvenile idiopathic arthritis
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease in children. It is classified into several subtypes based on symptoms and physical exam findings. Oligoarticular JIA affects 4 or fewer joints, typically large weight-bearing joints. Polyarticular JIA affects 5 or more joints within the first 6 months. Systemic onset JIA is characterized by spiking fevers and rash. Physical exam may reveal synovitis, limited range of motion, and joint swelling. Screening for uveitis is important for some subtypes.
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Approach to joint pain in child
An 11-year-old boy presented with fever, joint pain and swelling, and shortness of breath for 4 days. Examination found an enlarged heart, elevated inflammatory markers, and evidence of previous streptococcal infection. He was diagnosed with acute rheumatic fever. A 5-year-old boy had recurrent joint pain and swelling for 10 months. Testing found anemia and bone lesions. He was diagnosed with sickle cell disease. The document discusses approaches to evaluating joint pain, including questions to ask about symptoms and guidance for examining the joints, muscles, and skin.
Juvenile arthritis an overview
1. Juvenile idiopathic arthritis (JIA) is an autoimmune disease characterized by chronic joint inflammation in children.
2. JIA is classified into subtypes based on the number of joints affected and symptoms present. The most common subtypes are oligoarticular JIA affecting fewer than 5 joints, and polyarticular JIA affecting 5 or more joints.
3. Diagnosis involves ruling out other causes through medical history, physical exam, blood tests, and joint fluid analysis. Treatment aims to suppress inflammation and prevent long-term joint damage and disability. Prognosis is generally good, though some subtypes are associated with greater functional impairment.
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This document discusses juvenile idiopathic arthritis (JIA), including its definition, signs and symptoms, patterns of onset, and treatment approaches. JIA is the most common rheumatic disease of childhood and can be divided into subtypes based on characteristics. Treatment involves NSAIDs initially and may progress to DMARDs like methotrexate or biological agents if needed. Management of uveitis associated with JIA relies on regular screening by an ophthalmologist and corticosteroid therapy if detected. The goal of JIA treatment is to minimize inflammation, control pain, preserve movement, and promote development.
Juvenile idiopathic arthritis
Juvenile Idiopathic Arthritis (JIA) is a chronic form of arthritis that affects children. It has several subtypes including oligoarticular JIA (less than 5 joints affected), polyarticular JIA (5 or more joints affected), and systemic-onset JIA. Common symptoms include joint pain, swelling and stiffness. It is diagnosed by physical exam, lab tests, and ruling out other conditions. Treatment focuses on suppressing inflammation, preserving function, preventing deformity and blindness. Prognosis is generally good, though polyarticular and systemic-onset subtypes carry a higher risk of long-term disability.
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Lecture 1 .juvenile idiopathic arthritis
This document provides an overview of juvenile idiopathic arthritis (JIA), including its epidemiology, classifications, clinical presentations, and treatment approaches. JIA is the most common rheumatic disease in childhood, affecting about 1 in 1000 children. It encompasses a group of arthritides of unknown cause that begin before age 16. There are several subtypes of JIA classified by the ILAR system based on clinical features. Treatment involves medications like NSAIDs, corticosteroids, methotrexate, and biologics, with the goal of controlling inflammation and preventing long-term joint damage. Regular monitoring of patients on medications is important for safety.
Juvenile idiopathic arthritis (JIA)
is an umbrella term referring to a group of disorders characterized by chronic arthritis. JIA is the most common chronic rheumatic illness in children and is a significant cause of short-and long-term disability.
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A 10-year-old girl presented with pain and swelling in multiple small and large joints of both upper and lower limbs for the past 7 months. On examination, her knees, elbows, and small joints of hands and feet were swollen, warm, tender with restricted movement. Based on the symmetrical involvement of multiple joints, she was provisionally diagnosed with polyarticular juvenile idiopathic arthritis.
Approach to arhritis in children
This document discusses arthritis in children. It begins with definitions of arthritis and arthralgia and classifications of arthritis according to duration and number of joints involved. Common causes of acute, subacute, and chronic arthritis in children are described. Juvenile idiopathic arthritis is discussed in detail, including classification systems and management approaches. Specific conditions like septic arthritis, rheumatic fever, reactive arthritis, and sickle cell arthropathy are also summarized. The document concludes with a case scenario and emphasizes taking a thorough history and examination to diagnose childhood arthritis.
Acute flaccid paralysis (AFP)
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Ricket and osteomalacia
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An approach to a Floppy infant - Dr Sujit
Central nervous system involvement is a common cause of hypotonia in infants. A thorough history and physical exam seeks to determine if the origin is central or peripheral. Key aspects of the exam include assessing for proximal versus distal weakness, deep tendon reflexes, and distribution of weakness. Investigations such as EMG, nerve conduction studies, muscle biopsy and genetic testing can help characterize disorders of the motor unit to establish a diagnosis. Narrowing the likely etiology is important to guide management and prognostic expectations.
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Here are some key points regarding the feasibility of bacteriological diagnosis in children with TB:
- Sputum induction or gastric lavage are generally required to obtain specimens from children, as they typically cannot produce sputum on demand. This requires specialized equipment and trained personnel.
- Even with induced sputum or gastric lavage, specimen quality and volume may be low, reducing the sensitivity of bacteriological tests.
- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
SHORT STATURE
A 15-year-old male presents with concerns of short stature and delayed puberty. Differential diagnoses include gonadotrophin deficiency, gonadal failure, and constitutional delay of growth and puberty. Physical exam and bone age assessment support a diagnosis of constitutional delay of growth and puberty, which is a condition of temporary short stature and delayed puberty but normal expected progression and attainment of full adult height. Reassurance and monitoring are the typical management approach.
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease in children. It is classified into several subtypes based on symptoms and physical exam findings. Oligoarticular JIA affects 4 or fewer joints, typically large weight-bearing joints. Polyarticular JIA affects 5 or more joints within the first 6 months. Systemic onset JIA is characterized by spiking fevers and rash. Physical exam may reveal synovitis, limited range of motion, and joint swelling. Screening for uveitis is important for some subtypes.
Acute Flaccid Paralysis Lecture MBBS
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Approach to joint pain in child
An 11-year-old boy presented with fever, joint pain and swelling, and shortness of breath for 4 days. Examination found an enlarged heart, elevated inflammatory markers, and evidence of previous streptococcal infection. He was diagnosed with acute rheumatic fever. A 5-year-old boy had recurrent joint pain and swelling for 10 months. Testing found anemia and bone lesions. He was diagnosed with sickle cell disease. The document discusses approaches to evaluating joint pain, including questions to ask about symptoms and guidance for examining the joints, muscles, and skin.
Juvenile arthritis an overview
1. Juvenile idiopathic arthritis (JIA) is an autoimmune disease characterized by chronic joint inflammation in children.
2. JIA is classified into subtypes based on the number of joints affected and symptoms present. The most common subtypes are oligoarticular JIA affecting fewer than 5 joints, and polyarticular JIA affecting 5 or more joints.
3. Diagnosis involves ruling out other causes through medical history, physical exam, blood tests, and joint fluid analysis. Treatment aims to suppress inflammation and prevent long-term joint damage and disability. Prognosis is generally good, though some subtypes are associated with greater functional impairment.
Psoriatic arthropathy
Psoriatic arthritis is a chronic inflammatory disease that affects the joints and skin. It is characterized by osteolysis, bony proliferation, and can cause dactylitis, enthesitis, spondylitis, and various forms of arthritis. While it is classified as a type of spondyloarthritis, it is distinct from rheumatoid arthritis in that it is usually seronegative. The presentation and pattern of joint involvement in psoriatic arthritis can vary between patients and change over time, with the most common forms being asymmetrical oligoarthritis or symmetrical polyarthritis. Diagnosis is based on clinical features and classification criteria such as the CASPAR criteria.
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This document provides guidance on evaluating patients presenting with musculoskeletal complaints. It outlines the goals of accurate diagnosis, timely treatment, and avoiding unnecessary testing. The approach involves determining if the complaint is articular or non-articular, the nature of the pathologic process, extent of involvement, chronology, and most common differential diagnoses. A physical exam focuses on important signs like swelling, tenderness, range of motion, crepitation, and deformity to differentiate inflammatory from non-inflammatory conditions.
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Juvenile idiopathic arthritis
This document discusses juvenile idiopathic arthritis (JIA), including its definition, signs and symptoms, patterns of onset, and treatment approaches. JIA is the most common rheumatic disease of childhood and can be divided into subtypes based on characteristics. Treatment involves NSAIDs initially and may progress to DMARDs like methotrexate or biological agents if needed. Management of uveitis associated with JIA relies on regular screening by an ophthalmologist and corticosteroid therapy if detected. The goal of JIA treatment is to minimize inflammation, control pain, preserve movement, and promote development.
Juvenile idiopathic arthritis
Juvenile Idiopathic Arthritis (JIA) is a chronic form of arthritis that affects children. It has several subtypes including oligoarticular JIA (less than 5 joints affected), polyarticular JIA (5 or more joints affected), and systemic-onset JIA. Common symptoms include joint pain, swelling and stiffness. It is diagnosed by physical exam, lab tests, and ruling out other conditions. Treatment focuses on suppressing inflammation, preserving function, preventing deformity and blindness. Prognosis is generally good, though polyarticular and systemic-onset subtypes carry a higher risk of long-term disability.
Recent Advances In The Management Of Juvenile Idiopathic Arthritis
The term “rheumatologicaldisorders” refers to diseases that affect the major connective tissues of the body (e.g. skin, bone, blood vessels, cartilage and basement membrane).
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It was previously called as, Juvenile Rheumatoid Arthritis (by ACR –American College of Rheumatology) or Juvenile Chronic Arthritis (by ELAR –European League Against Rheumatism).
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This document discusses juvenile idiopathic arthritis (JIA), which encompasses a complex group of disorders comprising several clinical entities with the common feature of arthritis in children. It defines JIA and outlines its classification into 7 subtypes. It describes the epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment of JIA. The key subtypes discussed are oligoarticular JIA, polyarticular JIA, and systemic JIA. The goals of JIA treatment are to achieve remission, minimize medication toxicity, maximize function and improve quality of life for children with JIA.
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Juvenile rheumatoid arthritis (JRA) is a general term for arthritis in children. It is characterized by joint inflammation, swelling, and pain. There are different subtypes classified by the number and pattern of involved joints. Treatment has shifted to more aggressive early treatment with medications to prevent long-term joint damage, and may include NSAIDs, disease-modifying antirheumatic drugs like methotrexate, biologic medications, and corticosteroids depending on the subtype and severity of symptoms. JRA can cause long-term disabilities but early treatment aims to improve prognosis and prevent complications.
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Rare Pulmonary Diseases in Systemic JIA. This presentation tracks the increased use of biologics to treat SJIA and observes the trends in rare pulmonary diseases.
JIA clinical practice guidelines
This document provides clinical practice guidelines for the management of juvenile idiopathic arthritis (JIA). It discusses the background, epidemiology, risk factors, subtypes, clinical presentation, diagnostic studies, differential diagnosis, multidisciplinary management, medications, physical and occupational therapy, psychosocial interventions, complementary and alternative medicine, and implications for primary care providers of JIA. The goal of treatment is to control inflammation and pain, prevent morbidity and functional disability through a multidisciplinary approach including medications, physical therapy, and psychosocial support. Early recognition and treatment of JIA can positively impact outcomes.
Systemic JIA the Clinical Picture
This document discusses systemic juvenile idiopathic arthritis (S-JIA), including its clinical presentation, course, treatment and pulmonary complications. S-JIA is characterized by quotidian fever, evanescent rash, arthritis, lymphadenopathy, hepatosplenomegaly and serositis. It can follow a variable course from monophasic to persistent. Complications include macrophage activation syndrome (MAS), growth failure, joint damage and amyloidosis. New targeted biologics like anti-IL-1 and anti-IL-6 agents are the current recommended treatment approaches. The document also notes several reported cases of pulmonary hypertension and interstitial lung disease in S-JIA patients and questions what disease
JIA
Juvenile Idiopathic Arthritis (JIA) is a group of chronic joint conditions affecting children 16 years old or younger, requiring persistent arthritis for at least 6 weeks for diagnosis. It occurs in 100-400 cases per 100,000 children. JIA includes subtypes like systemic JIA characterized by a salmon-colored rash, polyarthritis JIA which can be rheumatoid factor positive or negative, oligoarticular JIA, enthesitis related JIA, and psoriatic JIA. Complications include damage to joints and difficulty walking. Differential diagnoses include transient synovitis.
Temporomandibular Joint Arthritis in Pediatric Inflammatory Arthropathies
Temporomandibular Joint Arthritis in Pediatric Inflammatory ArthropathiesArthritis Foundation 2012 JA Conference
Temporomandibular Joint Arthritis in Pediatric Inflammatory Arthropathies (TMJ) by Randy Q. Cron, MD, PhD, Univ. of Alabama at BirminghamJuvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), is a type of arthritis that causes joint inflammation and stiffness in children aged 16 or younger for more than six weeks. There are three main types of JRA: pauciarticular JRA which affects 4 or fewer joints, polyarticular JRA which affects 5 or more joints, and systemic JRA which causes symptoms unrelated to joints like fever and rash. The causes of JRA are unknown but it is an autoimmune disease where the immune system mistakenly attacks the body's own tissues in the joints. Symptoms include swollen or painful joints, fever, rash, and eye inflammation. Diagnosis
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Recent Advances In The Management Of Juvenile Idiopathic Arthritis
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419807346-Juvenile-Idiopathic-Arthritis.pptx
Here are the answers to the multiple choice questions:
1. B
2. B
3. C
4. B
5. D
Juvenile_Idiopathic_Arthritis.pptx
Juvenile Idiopathic Arthritis (JIA) is defined as arthritis of unknown cause that begins before age 16 and lasts over 6 weeks. It is classified based on symptoms into subtypes including systemic onset JIA, oligoarticular JIA, and polyarticular JIA. Treatment involves a stepwise approach starting with NSAIDs and intra-articular steroids and escalating to DMARDs and biologicals. Complications can include chronic anterior uveitis, osteoporosis, and potentially life-threatening macrophage activation syndrome.
Inflammatory markers and disease activity in juvenile idiopathic
This document discusses inflammatory markers and disease activity in juvenile idiopathic arthritis (JIA). It first defines JIA and its subcategories according to the International League of Associations for Rheumatology criteria. It then discusses the etiology and pathogenesis of JIA, including genetic susceptibility and abnormal immune responses involving both humoral and cellular mechanisms. The clinical manifestations of JIA are described for different subtypes, including symptoms involving joints, fever, rash, and visceral involvement. Laboratory findings and investigations for JIA are also outlined, such as elevated inflammatory markers and the role of imaging like MRI. Management of JIA is noted to be best provided in a specialized pediatric rheumatology setting.
Arthritis
This is a reference for arthritis and related disorders. However this should not be the substitute for standard text books.
Juvenile idiopathic arthritis
Juvenile Idiopathic Arthritis (JIA), formerly known as Juvenile Rheumatoid Arthritis, is the most common chronic rheumatologic disease of childhood. It is an autoimmune disease of unknown etiology characterized by chronic synovitis. There are several subtypes of JIA including oligoarticular, polyarticular, and systemic-onset JIA. The goals of treatment are to suppress inflammation, preserve joint function, prevent deformity, and prevent blindness which is a risk for children with JIA. The prognosis is generally excellent, though some subtypes have a higher risk of long-term disability.
Juvenile Idiopathic Arthritis: diagnosis and treatment
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that causes joint pain and swelling in children under 16 years old. It is the most common rheumatic disease in children. The cause is unknown but likely involves genetic and environmental factors. There are several subtypes of JIA classified by symptoms. Treatment aims to reduce inflammation and prevent joint damage through medications like NSAIDs, methotrexate, and biologics as well as physical and occupational therapy.
JIA1.ppt a basic approach to know about JIA
This document discusses juvenile idiopathic arthritis (JIA), including:
1. It defines JIA and differentiates it from other causes of arthritis in children.
2. It describes the different subtypes of JIA based on number of joints involved, presence of systemic features, and other characteristics.
3. It discusses the clinical features, investigations, treatment approaches, and complications of JIA through several case examples.
Juvenile Idiopathic Arthritis
Juvenile idiopathic arthritis (JIA) is a chronic form of arthritis in children under 16 years old that lasts over 6 weeks. The cause is unknown but believed to be autoimmune. There are several subtypes characterized by the number and type of joints involved and presence of systemic symptoms. Symptoms include joint swelling, pain, and stiffness. If untreated, JIA can cause joint damage and limited mobility. Treatment involves medications like NSAIDs, steroids, DMARDs, and biologics to reduce inflammation and prevent long-term issues. The goals are eliminating active disease, improving joint function, and allowing normal growth and development.
Spondylarthropathy
The document discusses several inflammatory arthropathies known as spondylarthropathies. They are commonly associated with the HLA B27 gene and involve entheses, synovium, and the spine. Major types include ankylosing spondylitis, psoriatic arthropathy, reactive arthritis, and enteropathic arthritis. They often present with enthesitis, uveitis, and spondylitis and are treated with NSAIDs, DMARDs, anti-TNF drugs, or surgery depending on the specific condition and symptoms.
jia final.pptx
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. It is classified into seven subtypes based on the number of involved joints, presence of specific symptoms or antibodies. The subtypes include systemic, oligoarticular, polyarticular (RF-negative and RF-positive), psoriatic, enthesitis-related, and undifferentiated arthritis. JIA is diagnosed clinically based on joint swelling or pain and exclusion of other causes. Laboratory tests like ANA, RF, and HLA-B27 can help classify the subtype but are not diagnostic. Imaging like X-ray and MRI are more sensitive than clinical exam in detecting early joint changes. Treatment
Ra dr s alam
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation of the synovium lining the joints, leading to pain, stiffness, and eventual joint damage and loss of function. It is characterized by symmetric inflammation of small joints of the hands and feet. While the exact cause is unknown, genetic and environmental factors are thought to play a role. Diagnosis is based on symptoms and serological markers like rheumatoid factor. Treatment aims to reduce inflammation and prevent further joint damage through medications like DMARDs and biologics, with the goal of improving quality of life and physical function.
Advancement in treatment of ra (1)
The document provides an overview of advancements in the treatment of rheumatoid arthritis. It discusses the disease characteristics and course, classification criteria, treatment objectives and guidelines, and various therapies including biologics. A case example is presented of a patient with joint pains and symptoms meeting classification criteria for rheumatoid arthritis.
Approach To A Patient With Polyarthritis
This document provides guidance on evaluating and diagnosing a patient presenting with polyarthritis. It outlines an approach involving assessing the site and distribution of pain, type of pain, associated features, duration and onset, risk factors, physical signs, differential diagnosis, and investigations. Key tests include radiographs, bloodwork including ESR/CRP, synovial fluid analysis, and serologic tests. Common arthritic conditions discussed include osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis, ankylosing spondylitis, and systemic lupus erythematosus.
μιμητες ιδιοπ αρθριτιδας 2017
When a Juvenile Idiopathic Arthritis is not a Juvenile Idiopathic Arthritis: An overview of the mimics
29o Συνέδριο Παγκρήτιας Παιδιατρικής Εταιρείας
Juvenile Idiopathic Arthritis / JIA.pptx
Most common rheumatic disease in childhood but prevalence and incidence vary remarkably in different geographic regions
•Incidence : 0.8 to 22.6/100,000 children per year
•Prevalence : 7 to 401/ 100,000.
•Oligoarticular JIA (30-60%): The peak age at onset : Between 2 and 4 yr, F/M: 3:1 Polyarticular (30-35%): Bimodal distribution with peaks at 1-4 yr and 10-14 yr, F/M: RF negative (3 : 1), RF positive (5 : 1) JIA.
• Systemic onset (10-20%): peak 1-5 years(No sex predominance)
• Enthesitis related arthritis (10-20%):Onset usually after 6 years
and M/F: 7:1
• Juvenile psoriatic arthritis (2-5 %): Bimodal distribution 1-4 yr and 10-14 yr
8
Etiopathogenesis
• Both immunogenetic susceptibility and an external trigger
• Variants in major histocompatibility complex (MHC) class I and class II regions
• Non-HLA candidate loci: polymorphisms in the genes encoding protein tyrosine phosphatase nonreceptor 22 (PTPN22), tumor necrosis factor (TNF)-α, macrophage inhibitory factor, interleukin (IL)-6, and IL-1α.
• External trigger: bacterial and viral infections, enhanced immune responses to bacterial or mycobacterial heat shock proteins, abnormal reproductive hormone levels, and joint trauma.
9
10
• All these cause inflammatory synovitis, characterized by villous hypertrophy and hyperplasia with hyperemia and edema of synovial tissue.
• Vascular endothelial hyperplasia is prominent and is characterized by infiltration of mononuclear and plasma cells with a predominance of T lymphocytes
• Advanced and uncontrolled disease leads to pannus formation and progressive erosion of articular cartilage and contiguous bone
11
Genetics
• Monozygotic twins : 25% to 40% • Siblings : 15 to 30 fold higher
• Role of HLA class I and II alleles
HLA B27 Enthesis related arthritis
HLA-A2 is associated with early-onset JIA
HLA-DRB1*08, 11, and 13 and DPB1*02 :oligoarticular JIA. HLA-DRB1*08 : Rf negative polyarticular JIA.
12
JRA
13
• Age: <16 years & Duration : > 3 months
Subtypes (Based on characteristics at onset):
JCA
• Pauciarticular (1-4 joints)
• Polyarticular (≥5 joints)
• Presence of RF (2 positive tests at least 3 months apart) • Systemic onset with characteristic features
• Juvenile ankylosing spondylitis
• Juvenile psoriatic arthritis
14
• Age: <16 years & Duration : > 6 weeks
• Systemic onset JIA
• Oligoarticular JIA : Persistent and extended
• Polyarticular JIA : RF positive and RF negative • Psoriatic arthritis
• Enthesitis related arthritis
• Undifferentiated arthritis
JIA
15
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Clinical features
Symptoms (Arthritis must be present to make a diagnosis of any JIA subtype):
Signs:
• Early:
• Swelling
• Warm on palpation
• Tenderness but not erythematous • Restricted ROM
• Antalgic gait
• Late:
• Deformities
• Growth disturbances
• Pain
• Swelling
• Stiffness following inactivity
• Easy fatigability and poor sleep quality
17
Systemic onset JIA
Arthritis in ≥1 joint with, or preceded by, fever of at least 2 weeks time.
Juvenile idiopathic arthiritis 2019
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease affecting children under 16 years of age. It is classified into subtypes including oligoarticular, polyarticular, systemic, psoriatic, and enthesitis-related arthritis. Genetic and environmental factors may play a role in its etiology. Treatment involves medications like NSAIDs, DMARDs such as methotrexate, and biologics targeting cytokines. The goals of treatment are to control inflammation, relieve symptoms, prevent joint damage, and maintain physical function. A multidisciplinary approach including medications, physical therapy, and psychosocial support can help improve quality of life for children with JIA.
Juvenile idiopathic arthritis (JIA)
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Child with a limp
This document discusses the evaluation and diagnosis of a child presenting with a limp. It notes that limp is a symptom, not a diagnosis, and the causes can vary depending on the child's age. A thorough history and physical exam are important to identify potential causes such as trauma, infection, bone diseases, or non-accidental injury. Common etiologies in different age groups are described. Red flags indicating serious conditions like sepsis or malignancy that require prompt management are also provided. Guidance on targeted investigations and management strategies for conditions like transient synovitis or Legg-Calve-Perthes disease are summarized.
Rheumatic disorders summary
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, causing swelling and stiffness, eventually resulting in deterioration of bone and cartilage. It is caused by an autoimmune response and is characterized by symmetric inflammation of multiple small joints of the hands and feet. Symptoms progress from early inflammation to joint destruction and deformity if left untreated.
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Juvenile Idiopathic Arthritis
- 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. 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. 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. 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. 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. 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. 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. 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. 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. Differential Diagnosis • Infections – ARF, osteomyelitis, TB • Malignancy – Leukaemias • Other CTDs – SLE, juvenile dermatomyositis 11
- 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. 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. 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. 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. THANK YOU 16