Term
|
Definition
preceded by 2 weeks of fever and at least 1 of the following? evanescent, non-fixed erythematous rash, lymphadenopathy, hepatosplenomegaly, serositis
mean age: 4-6 yo
affects any joints
F:M (1.5:1) |
|
|
Term
| What are the clinical symptoms of systemic JA? |
|
Definition
| arthritis: knees, elbows, MCPs, ankles axillary lymphadenopathy hepatosplenomeg evanescent rash quotidian (1x/day) fever pattern |
|
|
Term
| What condition exhibits a quotidian (1x/day) fever pattern? |
|
Definition
|
|
Term
| What do you seen in lab eval of a patient w/systemic onset JA? |
|
Definition
leukocytosis
anemia
thrombocytosis
^ESR & CRP
^ferritin (correlates w/disease activity) |
|
|
Term
| In what condition do you see increased levels of ferritin which correlates to disease activity? |
|
Definition
|
|
Term
| What are the complications of systemic onset JA? |
|
Definition
macrophage activation system: macrophages expand uncontrolably when NK cells don't work
rapid development of hepatic failure w/enceph
purpura, bruising, mucosal bleeding assoc w/renal failure
persistent fever
leukopenia, anemia, thrombocytopenia, decreased ESR
cytokin storm |
|
|
Term
| How is systemic onset JA treated? |
|
Definition
IV metylprednisone, cyclosporin A, anti IL1 & IL6
high fatality rate :-( |
|
|
Term
|
Definition
F:M (3:1)
peak age 1-3
arthritis w/uveitis
seldom familial
no more than 4 jts in first 6 months (persistent: never > 4, extended: >4 over time) |
|
|
Term
| In what condition do you see severe erosions & joint space narrowing after 10 years? |
|
Definition
|
|
Term
| What are the clinical symptoms of oligoarticular JA? |
|
Definition
not systemically ill
predominanly LEs: one or both knees, ankles; can affect small jts of fingers/toes but less common
pain at extreme ROM
aching/stretching
pain elicited by pressure or tenderness, maximum at joint line or inflamed synovium
compensatory positions |
|
|
Term
| What JIA primarily effects the lower extremities? |
|
Definition
|
|
Term
| In what condition do you see compensatory positions? |
|
Definition
|
|
Term
| How is pain elicited in oligarticular JIA? |
|
Definition
extreme ROM
pressure or tenderness, maximal and joint line or inflamed synovium |
|
|
Term
| How is oligoarticular JIA diagnosed? |
|
Definition
chronic arthritis in less than 4 jts
ANA, RF
leg length discrepancy
micrognathia
brachydactyly |
|
|
Term
| In what condition do you see a leg length discrepancy? |
|
Definition
|
|
Term
| In what condition do you see micrognathia (small jaw) and brachydactyly (short fingers/toes)? |
|
Definition
|
|
Term
| What are the complications of poly/oligoarticular JIA? |
|
Definition
micrognathia
cerv spine involvement
risk of allantoaxial subluxation & SC compression
Baker's (popliteal) cyst |
|
|
Term
| Which of the JIAs has the best outcome? |
|
Definition
|
|
Term
| What are the age groups affected by systemic onset vs oligoarticular vs polyarticular JIA? |
|
Definition
systemic: 4-6yo
oligoarticular: 1-3yo
polyarticular: adolescent onset |
|
|
Term
| Which JIA has the greatest female:male ratio? |
|
Definition
|
|
Term
| Which gender is most affected by JIAs? |
|
Definition
|
|
Term
|
Definition
F:M (3.5:1)
RF (+) on at least 2 ocasions separated by 3 months
arthritis in at least 5 joints in the first 6 months
adolescent onset |
|
|
Term
| What are the clinical symptoms of polyarticular JIA? |
|
Definition
adolescent onset
symmetric joint involvement
rheumatoid nodules
rheumatoid vasculitis |
|
|
Term
| In what JIA do you see rheumatoid nodules? |
|
Definition
|
|
Term
|
Definition
ANA+ girls are at increased risk
bilateral
frequently asymptomatic
typically diagnosed withing 7yrs of JIA diagnosis
should screen every 3-4 months |
|
|
Term
| What are complications of JIA associated uveitis? |
|
Definition
| glaucoma, cataracts, band keratopathy, posterior synechial, vision loss |
|
|
Term
| What are the criteria for enthesis-related disease? |
|
Definition
arthritis & enthesitis or
arthritis or enthesitis with at least 2: SI jt tenderness/inflamm spinal pain
HLA b27
family hx of b27-related disease
acute anterior uveitis
onset of arthritis in boy >8yo
exclusions: psoriasis or sytemic features |
|
|
Term
| List the features of acute anterior uveitis. |
|
Definition
unilateral
painful
redness
tearing
photophobia |
|
|
Term
| Describe the arthritis in enthesitis-related arthritis. |
|
Definition
lower extremities
isolated hip disease is common
tarsitis: pain and decreased motion of midfood
toes commonly involved but not fingers
SI joint involvement
spinal involvement |
|
|
Term
| In what condition do you see tarsitis? |
|
Definition
| enthesitis-related arthritis |
|
|
Term
|
Definition
inflammation of tendons/ligaments at their attachment sites to bones
common sites: 2,6, & 10 o'clock around patella
tibial tuberosity
achilles tendon attachment at calcaneous
plantar fascia attachment at calcaneous
heads of metatarsals
base of 5th metatarsal |
|
|
Term
| What is seen in psoriatic arthritis? |
|
Definition
hidden psoriatic lesions: nail pitting, navel & gluteal crease
+ family hx of psoriasis
may look like pauci/oligoarticular but labs are worse (high inflamm markers)
dactylitis (sausage fingers)
prognosis is generally worse |
|
|
Term
| In what condition do you see dactylitis? |
|
Definition
| psoriatic arthritis (sausage fingers) |
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