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:
It 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.
Rheumatoid factor +ve in 10-20% of cases.
- ANA is positive in 20-40% of cases.
- 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.
joints may occur, psoriasis may be present in the child or a first degree
relative.
• 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.
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)
It 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 smalljoints 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.