Juvenile idiopathic arthritis
From Wikipedia, the free encyclopedia
| ICD-10 | M08.0 |
|---|---|
| ICD-9 | 714.3 |
Juvenile Idiopathic Arthritis (JIA), formerly known as Juvenile Rheumatoid Arthritis (JRA) or Juvenile Chronic Arthritis (JCA),<ref>Ringold S, Burke A, Glass R (2005). "JAMA patient page. Juvenile idiopathic arthritis.". JAMA 294 (13): 1722. PMID 16204672.</ref> is the most common form of persistent arthritis in children. Arthritis means inflammation of the synovium (the lining tissues) of a joint.
Contents |
[edit] Symptoms
Symptoms of JIA are often non-specific initially, and include lethargy, reduced physical activity, and poor appetite. The first manifestation, particularly in young children, may be limping. The cardinal clinical feature is persistent swelling of the affected joint(s), which commonly include the knee, ankle, wrist and small joints of the hands and feet. Swelling may be difficult to detect clinically, especially for joints such as those of the spine, sacroiliac joints, shoulder, hip and jaw, where imaging techniques such as ultrasound or MRI are very useful.
Pain is an important feature of JIA, but young children may have difficulty in communicating this symptom. Late effects of arthritis include joint contracture (stiff, bent joint) and joint damage. Children with JIA vary in the degree to which they are affected by particular symptoms.
[edit] Associated Complications
1. Eye disease: JIA is associated with inflammation in the front of the eye (chronic anterior uveitis). This complication may not have any symptoms and can be detected by an experienced ophthalmologist using a slit lamp. Most children with JIA are enrolled in a regular slit lamp screening program, as poorly controlled chronic anterior uveitis may result in permanent eye damage, including blindness.
2. Growth disturbance: Children with JIA may have reduced overall rate of growth, especially if the disease involves many joints or other body systems. Paradoxically, individually affected large joints (such as the knee) may grow faster, due to inflammation - induced, increased blood supply to the bone growth plates situated near the joints
[edit] Onset
JIA can occur in boys or girls of any age, but symptoms most commonly begin during the toddler or early teenage years.
[edit] Prevalence
Juvenile idiopathic arthritis is one of the most common chronic inflammatory diseases of children, affecting between 1-4 in every 1,000 children (an estimated 300,000 children in the United States).[citation needed] No one knows what causes JIA. Theories include both genetic and environmental factors.
[edit] Types of JIA
There are several clinically distinct subtypes of JIA. The most commonly recognised are oligoarthritis, polyarthritis and systemic arthritis. Other subtypes include extended oligoarthritis, psoriatic arthritis and enthesitis related arthritis. Most children with JIA have disease that is clearly different from the most common types of arthritis in adults (osteoarthritis and rheumatoid arthritis), but there is some overlap, particularly with psoriatic arthritis and enthesitis related arthritis (which may progress to ankylosing spondylitis).
</table>
[edit] Oligoarthritis
Oligoarthritis affects 4 or fewer joints. Oligo means few. It was previously known as pauciarticular JRA or JCA. Patients with oligoarthritis are often ANA positive, particularly in those at highest risk of chronic anterior uveitis.<ref> (2004) "Uveitis and Anti Nuclear antibody Positivity in Children with Juvenile Idiopathic Arthritis.". Indian Pediatr 41 (10): 1035-1039. PMID 15523130.</ref>
[edit] Polyarthritis
Affecting 5 or more joints.
[edit] Systemic Arthritis
Is characterized by arthritis, fever and a salmon pink rash. Systemic JIA can be challenging to diagnose because the fever and rash come and go. It affects males and females equally, unlike the other two subtypes of JIA.
Systemic JIA may have internal organ involvement and lead to serositis (e.g. pericarditis).
[edit] Treatment
The treatment of JIA is best undertaken by an experienced team of health professionals, including paediatric rheumatologists, nurse specialists, physiotherapists, occupational therapists and psychologists. Many others in the wider health and school communities also have valuable roles to play, such as ophthalmologists, dentists, orthopaedic surgeons, school nurses and teachers, careers advisors and, of course local general practitioners, paediatricians and rheumatologists. It is essential that every effort is made to involve the affected child and their family in disease education and balanced treatment decisions.
There have been very beneficial advances in drug treatment over the last 20 years. Most children are treated with non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections. Methotrexate is a powerful drug which helps suppress joint inflammation in the majority of JIA patients with polyarthritis and systemic arthritis. Newer drugs have been developed recently, such as TNF alpha blockers, which appear to be effective in severe JIA. There is little or no controlled evidence to support the use of alternative remedies such as specific dietary exclusions, homeopathic treatment or acupuncture.
[edit] See also
- Dr Barbara Ansell, pediatric rheumatologist.
[edit] External links
[edit] References
<references/>
