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1. JUVENILE RHEUMATOID
ARTHRITIS AND OTHER
IMMUNOLOGICAL
CONDITIONS
-NEENA VARGHESE

2. WHAT IS ARTHRITIS???
• ARTHRITIS-Arthritis is an inflammation of the joint,
characterized by pain swelling and limitation of
movement.
• RHEUMATIC ARTHRITIS-As per the American
Rheumatism Society, rheumatic arthritis is a chronic
non-suppurative inflammation of the synovial joints.
• JUVENILE ARTHRITIS: It is an auto-immune disorder
with inflammation of the synovium in children aged
16 or younger.

3. TYPES OF JRA
• Polyarticular JA affects five or more joints and:
• affects girls more frequently than boys
• most commonly affects knees, wrists and ankles
• can affect weight-bearing and other joints, including hips, neck, shoulders and jaw
• often affects the same joint on both sides of the body
• Pauciarticular JA affects four or fewer joints and:
• usually affects the large joints: knees, ankles or wrists
• often affects a joint on one side of the body only, particularly the knee
• may cause eye inflammation (uveitis) which is seen most frequently in young girls
with positive anti-nuclear antibodies (ANA)
• Systemic Onset JA can:
• affect boys and girls equally
• ocause high, spiking fevers of 103 degrees or higher, lasting for weeks or even
months
• cause a rash consisting of pale, red spots on the child’s chest, thighs and
sometimes other parts of the body
• cause arthritis in the small joints of the hands, wrists, knees and ankles

4. OTHER TYPES
• Juvenile Spondyloarthropies (ankylosing spondylitis, seronegative
enthesopathy and arthropathy syndrome) are a group of diseases
that involve the spine and joints of the lower extremities, most
commonly the hips and knees.
• Juvenile Psoriatic Arthritis is a type of arthritis affecting both girls
and boys that occurs in association with the skin condition
psoriasis.Distal interphalangeal joint is usually involved.
• Juvenile Dermatomyositis is an inflammatory disease that causes
muscle weakness and a characteristic skin rash on the eyelids.
• Juvenile Systemic Lupus Erythematosus is an autoimmune disease
associated with skin rashes, arthritis, pleurisy, kidney disease and
neurologic movement.Joint involvement is not symmetrical.
• Juvenile Vasculitis is an inflammation of the blood vessels and can be
both a primary childhood disease and a feature of other syndromes,
including dermatomyositis and systemic lupus erythematosus.

5. CAUSES
• Idiopathic
• not contagious and there is no evidence that
foods, toxins, allergies or vitamin deficiencies
play a role.
• May be due to Genetics or environmental
triggers

6. PATHOGENESIS
Synovium becomes oedematous and is filled with fibrin exudates
and cellular infiltrates
Synovium becomes hyperthrophied and surrounds the articular
cartilage to form a pannus.
Pannus extends from the cartilage into the subchondral bone
With progression cartilage becomes worn off and joint gets
deformed
Development of adhesions leading to fibrous ankylosis and later
bony ankylosis.

7. STAGES OF RHEUMATOID ARTHRITIS
1. Potentially reversible soft tissue
proliferations(synovial hypertrophy present ,no
changes in the xray)
2. Controllable but irreversible soft tissue
destruction(xray shows reduction in joint space
but outline of the articular cartilage is
maintained)
3. Irreversible soft tissue and bony changes(bones
become ankylosed.May lead to subluxation or
deformation.

8. SIGNS AND SYMPTOMS
• Pain, swelling, tenderness and stiffness of joints,
causing limited range of motion
• Joint contracture, which results from holding a
painful joint in a flexed position for an extended
period
• Limping
• Persistent fever,weight loss,fatigue
• Damage to joint cartilage and bone leading to joint
deformity and impaired use of the joint
• Altered growth of bone and joints leading to short
stature

9. DEFORMITIES
• Hand-boutonniere deformity, swan neck
deformity, Z deformity of thumb
• Ulnar deviation, fixed flexion deformity
• Elbow-flexion deformity
• Knee-flexion deformity
• Ankle-equinus deformity
• Foot-Hallux valgus,hammer toe.
• Cervical-atlanto-axial subluxation
• Others-leg length discrepancy, growth delay

11. INVESTIGATIONS
• Reduced joint space
• Subchondral cysts
• Erosion of articular margins
• Elevated ESR
• Low heaoglobin

12. GOALS
• control inflammation
• relieve pain
• prevent deformity
• reduce swelling
• maximize functional abilities.
• Protect joints fro further damage
• Improve flexibility and strength.
• Encourage regular exercise
• Improve general fitness.

13. TREATMENT
• MEDICAL TREATMENT: NSAIDS DMARD
methotrexate Steroids
• ORTHOPAEDIC TREATMENT: Prevention of
deformity, preservation of joint functions.
• PHYSIOTHERAPY TREATMENT: Splinting, heat
therapy,joint mobilization, walking aids,
strengthening excs
• OPERATIVE TREATMENT: Synovectomy, soft
tissue repair arthroplasty, arthrodesis

15. THANK YOU.