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Juvenile idiopathic chronic arthritis types, diagnosis and treatment

Definition of juvenile idiopathic arthritis
 Juvenile chronic arthritis is chronic inflammatory arthritis before age 16 years for at least 6 weeks.
• It can be divided into the following types:

(1)Systemic onset arthritis (Still's disease)

Juvenile-idiopathic-chronic-arthritisIt affects boys and girls, adult onset still's disease is rare.
- Prominent systemic complaints and extra articular involvement.
- Fever, rash (non pruritic fleeting maculopapular rash).
- Lymphadenopathy, hepatosplenomegally.
- Pericarditis, pleurisy.
- Arthritis or arthralgia and mylagia.
Rheumatoid factor usually is negative.
- High ESR and CRP, neutrophilia and thrombocytosis.

(2) Polyarticular arthritis (5 joints or more)

Bilateral symmetrical polyarthritis specially hands, wrists, PIP and DIP.
Rheumatoid factor +ve in 10-20% of cases.
- ANA is positive in 20-40% of cases.

(3)Pauciartieular arthritis.

(a) Oligoarthritis and anterior uveitis:
- Affects up to 4 joints (four or fewer joints) especially wrists, knees, ankles.
- -ve rheumatoid factor.
Uveitis, this requires regular screening by slit-lamp, blindness may occur.
Positive ANA in 60% of patients, which identifies those at higher risk factor for chronic uveitis.
Negative rheumatoid factor.
(b) Axial skeletone oligoarthritis:
- Asymmetrical knee, ankle arthritis, followed by sacroiliac joints, uveitis can occur, 50% of patients have HLA-B27 but few have positive rheumatoid factor.

(4) Psoriatic arthritis:

- This affects fingers and toes, also polyarthritis involving large and small
joints may occur, psoriasis may be present in the child or a first degree
relative.

Treatment of juvenile chronic arthritis

• Salicylates are no longer the primary drugs used in the treatment of juvenile arthritis due to the potential precipitation of Reye's syndrome.
• Other NSAIDs with low doses and paracetamol are helpful as regard pain and stiffness.
Methotrexate, the most commonly used second line agent. Leflunomide is also effective. Sulfasalazine is also used.
• Corticosteroids are used with systemic complaints e.g pericarditis, also in the treatment of chronic uveitis (Local or systemic).
• Intravenous infusion of gamma globulin to control severe systemic onset or polyarticular disease.
• Physical and occupational therapy.
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Tamer Mobarak

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