JIA is a preferred term for non-infective inflammatory joint disease in children under 16 years. It includes several disorders affecting a few or more large joints. Systemic JIA is characterized by intermittent fever, rash, and malaise, along with joint swelling and inflammation. Pauciarticular JIA most commonly affects young girls and involves only a few joints like the knees and ankles. Polyarticular JIA typically involves more joints including the hands/wrists and sometimes the jaw and neck. Treatment involves medications like corticosteroids, methotrexate, and cytokine inhibitors to reduce inflammation and physiotherapy to prevent joint deformities.

1. JUVENILE IDIOPATHIC
ARTHRITIS
Dr Muthoka

2. • Jia is a preferred term for non-infective inflammatory jt disease of
more tha 3 months duration children under 16 yrs
• It embraces a group of disorders affecting a few of the larger joints-
about 10% present with particular arthritis
• Sometimes closely resemble r.a-5-10 % can develop seronegative
polyarthritis

3. SYSTEMIC JIA
• This is the classic stills dx, is usually seen below the age of 3 yrs
• Affect boys and girls equally
• Start with intermittent fever ,rash & malaise
• During these episodes which occur almost daily the of appear quite ill
but a few hours later the clinical condition improve again
• Less constant features are lymphadeopathy, splenomegaly &
hepatosplenomegaly
• It swelling occur some weeks or months after the onset
• It usually resolves when the systemic illness subsides

4. • But it may go on progressive seronegative polyarthritis; leading to
permanent deformity of the large joints
• By puberty there may be stunting of growth, often abetted by earlier
use of corticosteroids

5. Pauciarticular jia
• This is by far the commonest form of his
• Usually occur below the age of 6 yrs
• Is much more common in girls
• Occasionally older children are affected
• Only a few joints are involved
• There is no systemic illness
• Present with a pin &swelling of medium sized jts; knee,ankle,elbow&
wrist
• Sometime only 1 it is affected.

6. • Th factor is negative but ANA positive
• Complications
• Chronic iridocyclitisin about 50% of pts
• The arthritis goes into remission after a few yrs but the child is left
with assymetrical deformities and growth defect may be permanent

7. POLYARTICULAR JIA
• Typically with involvement of the tempiromandibular joint & the
cervical spine.
• Usually seen in older children mainly girls
• The hands & wrist are often affected but the classic deformities of rh
arthritis are uncommon & th factor is usually absent
• In some cases the condition is indistinguishable from adult th
arthritiswith a +ve th factor& is called JUVENILE rheumatoid arthritis

8. Seronegative spondyloarthropathy
• In older children, usually boys;the condition may the form of
sacroiliitis& spondylitis
• Hips and knees are sometimes involved as well
• HLA B27is positive
• JUVENILE ankylosing spondylitis.

9. Xray
• Early- soft tx swelling
• Late-progressive joint erosion & deformity

10. Ixs
• Fhg-increase in bbc and eat
• Rh factor test are +ve in jra
• Jt aspiration& fluid examination to exclude infection or hemarthrosis
• DIAGNOSIS
• EARLY stages diagnosis is difficult
• Start like viral infection

11. Ddx
• Pauciarticular
• Reiters dx &
• Septic arthritis acute
• Tb synovitis chronic
• Rh fever
• Bleeding disorder
• Leukaemia
• When pattern of it involvement is established diagnosis become clear
• May require
• Blood ix, it aspiration, synovial biopsy.

12. Rx
• Systemic dx is similar to that of rh arthritis
• Hydrochlorquine
• Sulfasalazine
• Methotrexate
• Corticosteroids used only for severe systemic dx
• & for chronic iridicyclitis unresponsive to topical therapy
• Severe inflammatory dx may need to betrayed with cytokine
inhibitors such as anti tend therapies.

13. LOCAL RX
• Priorities are to.prevent stiffness &dx
• Night splints may be useful for wrists, hand, knees,& ankle
• Prone lying for some period each day may prevent flexion
contracturesof hip
• Exercise & physiotherapy
• Fixed deformity may need correction by serial plaster
• Jt capsuloromy
• Custom designed arthroplasties of hip& knee.
• Arthrodesis of the wrist or ankle

14. Complications
• Ankylosis-loss of it not
• Growth defects; corticosteroids use/epiphyseal disturbance
• Fractures –osteoporosis
• Iridoxyclitis- ANA +ve . Untreated may lead to blindness
• Amyloidosis
• PROGNOSIS
• Most children left with only moderate deformity& limitation of fxn
• 5-10%are severely crippled & require rx through out life
• 3% die of renal failure due to amyloidosis.