Juvenile Idiopathic Arthritis Ooty Pedicon 2005 pediatric oncall

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Juvenile Idiopathic Arthritis

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JUVENILE IDIOPATHIC ARTHRITIS

OOTY PEDICON - 2005

Dr. RAJU KHUBCHANDANI
Pediatric Rheumatology Clinic, Jaslok Hospital,
Mumbai, India.

"Pain is inevitable. Suffering is optional" Anonymous.

Introduction

Juvenile Idiopathic Arthritis (JIA), previously known as juvenile rheumatic disorder of childhood is characterized by synovitis and systemic features.

Classification of JIA

Chronic arthritis in children represents a heterogeneous group of diseases with unknown etiology. Previously, there were two classification systems for chronic arthritis in childhood. To classify these patients in well-defined diagnostic categories, a task force of the International League Against Rheumatism (ILAR) proposed a new classification with precise criteria with the aim of achieving as much homogeneity within categories as possible.

ILAR Classification

Polyarthritis (> 4 joints in first six months of disease)

RF positive
RF Negative

Oligoarthritis

Persistent (<5 joints in first six months of disease)
Extended oligoarthritis (onset is oligoarticular but > 4 joints affected in first year)

Systemic onset (arthritis with typical rash and fever)

Enthesitis related arthritis (arthritis with enthesitis)

Psoriatic arthritis (arthritis with typical skin lesions, a family history of psoriasis, dactylitis or nail abnormalities)

Others (non of above / overlap)

Clinical and Laboratory Features:

	Systemic onset	Polyarticular RF+	Polyarticular RF-	Oligoarticular	Extended Oligoarticular
Incidence (%) Age Sex Articular Features	20-25 Any F=M Days to months later. Mean 3 months. Polyarticular. Large joints including hip and wrist. Small joints of upper extremity> lower extremity. Cervical spine and t.m. joint less affected.	5-7 10 yrs + F:M 2:1 Small joints of hands and feet, wrists and carpals. Ankles and knees also common> 4 joints. Family history of RA in about 25% (may post-date child's illness).	20-25 10 yrs - F> M Rapidly progressive involvement of > 4 joints. Cervical spine and t.m. joint often involved.	30-35 Peak 1-3 yrs F:M 4:1 Usually 1-2 joints. Rarely 3-4 Knee, elbow and ankle common. Cervical spine and t.m. joint rare.	10-15 Any F> M Onset oligoarticular. By end of first year follows a polyarticular course.
Extra-articular Features	Classic quotidian fever. Well between spikes should be present at least 2 weeks as a diagnostic criterion. Truncal evanescent rash often labeled as drug rash. Hepatosplenomegaly, adenopathy, pleuritis and pericarditis (often silent), rarely pulmonary, cardiac and neurological features.	Tenosynovitis common. Subcutaneous nodules on forearm in 30% Lassitude, fever and weight loss rare.	Low grade fever in a third	Almost none	Almost none
Acute phase reactants	Significant elevation. Polymorphonuclear response	Mild elevation	Normal to mild elevation	Normal to mild elevation	Mild elevation
ANA	Usually negative	May be positive	Positive in a third	Positive in 40-75%. Usually in low dilutions. May develop over time. Repeat in a year in negative.	Similar oligoarticular onset.
RA	Usually negative	Strong positive in weeks to months from onset. 3 positive results in a year eliminate other transient positivity states.	Negative	Rare (<5%)	Rare
Synovial fluid	Examination not usually necessary	Examination not usually necessary	Examination not usually necessary	<25000 WBC/cu mm polymorph response. Proteins elevated. Glucose within 10% of blood glucose.	Similar to oligoarticular onset
Outcome	Flares may be precipitated by viral and other illnesses. About half have a remission at one year. The rest may have a polyarticular course with about half of them developing end stage arthritis.	Chronic arthritis. May require life- long therapy.	Usually good. Requires aggressive management.	Excellent. Majority have remission in one year.	More severe course then those who remain oligoarticular. Requires aggressive management.

A. The Conventional Pyramid Approach:

The inverted pyramid approach is preferred to the conventional pyramid approach as early control of inflammation is achieved with a combination of rapid acting anti-inflammatory medications & slower acting second line drugs.

Key Message:

Juvenile Idiopathic Arthritis (JIA) is the present terminology for Juvenile Rheumatoid Arthritis.
JIA is the most common chronic rheumatic disorder of childhood.
International league against Rheumatism has classified this disease entity based on precise criteria.
The inverted Pyramid approach is preferred to the conventional pyramid approach so as to achieve early disease control as well as remarkable long-term benefits.

Last Updated on 01-10-2005

How to cite this url

Ooty Pedicon 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2005 [cited 01 October 2005];2. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
juvenile_idiopathic_arthritis.asp

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