Juvenile idiopathic arthritis - Chronic
Definition
A group of several types of arthritis in children younger than 16 years of age characterized by chronic joint inflammation that lasts for longer than 6 weeks and for which all other diagnoses have been excluded
Medical History
* Family history of Juvenile idiopathic arthritis
* Stress
* Joint injury
* Infectious disease
Findings
* Arthralgia
* Joint tenderness
* Joint swelling
* Limitation of joint movement
* Morning stiffness - joint
* Limping
* Fatigue
* Fever with chills
* Rash
* Lymphadenopathy
* Hepatosplenomegaly
* Subcutaneous rheumatoid nodule
* Stiff back
Tests
Initial workup of patients with suspected juvenile idiopathic arthritis
* Complete blood count
Suspected and known rheumatoid arthritis
* Urinalysis: Urinalysis is normal in early rheumatoid arthritis, and abnormal findings may signal drug nephrotoxicity or amyloidosis .
Rheumatoid arthritis
* Erythrocyte sedimentation rate measurement
* ANA measurement
Suspected or known juvenile idiopathic arthritis
* Rheumatoid factor measurement: A positive RF is not diagnostic of juvenile idiopathic arthritis but may appear in a subset of patients with polyarticular disease indicating a worse prognosis .
Suspected or known rheumatoid arthritis
* Joint X-ray: Changes seen on plain radiography that are characteristic of rheumatoid arthritis include erosions or loss of density adjacent to affected joints .
Differential Diagnosis
* Juvenile idiopathic arthritis, oligoarthritis
* Polyarticular juvenile rheumatoid arthritis, chronic
* Systemic onset juvenile chronic arthritis
* Juvenile idiopathic arthritis, enthesitis related arthritis
* Juvenile psoriatic arthritis
* Juvenile idiopathic arthritis, undifferentiated arthritis
* Osteomyelitis - Acute
* Septic arthritis - Acute
* Gonococcal infection of joint
* Arthritis due to viral infection
* Traumatic AND/OR non-traumatic injury
* Systemic lupus erythematosus
* Rheumatic fever - Acute
* Post-streptococcal reactive arthritis
* Autoimmune disease
* Kawasaki disease - Acute
* Leukemia
* Neoplastic disease
* Lyme disease
* Henoch-Schönlein purpura - Acute
* Growing pains
* Sarcoidosis
* Hand-foot syndrome in sickle cell anemia
* Hemoglobin SS disease with crisis
* Osgood Schlatter disease
Treatment
Drug Therapy
First line therapy for controlling pain and inflammation in children with juvenile idiopathic arthritis
NAPROXEN
Pediatrics: 15 to 20 mg/kg in 2 divided doses daily (maximum 500 mg/dose)
IBUPROFEN
Pediatrics: 40 mg/kg in 3 divided doses daily (maximum 800 mg/dose)
TOLMETIN SODIUM
Pediatrics: 20 to 30 mg/kg in 3 divided doses daily (maximum 600 mg/dose)
Synovitis in patients with oligoarticular or polyarticular juvenile idiopathic arthritis
TRIAMCINOLONE HEXACETONIDE
Pediatrics (large joints): Inject 1 mg/kg intra-articularly
Pediatrics (small joints): Inject 0.5 mg/kg intra-articularly
Second-line therapy for controlling pain and inflammation in patients with polyarticular juvenile idiopathic arthritis (JIA) and in oligoarticular and psoriatic JIA patients who do not respond to first-line treatment
METHOTREXATE SODIUM
Pediatrics: 0.3 mg/kg/week increasing to a maximum of 1 mg/kg per dose orally (maximum 25 mg/week) OR 15 mg/m2 subcutaneously (maximum 50 mg/m2)
SULFASALAZINE
Second-line therapy for patients with systemic onset juvenile idiopathic arthritis
METHYLPREDNISOLONE SODIUM SUCCINATE
Alternative therapy for juvenile idiopathic arthritis patients who do not respond to methotrexate
ETANERCEPT
Pediatrics: 0.4 mg/kg subQ twice weekly (maximum 25 mg/dose)
Procedural Therapy
Juvenile idiopathic arthritis
* Physical therapy procedure: Physical and occupational therapy may help maintain and improve range of motion, muscle strength, and skills for activities of daily living .
Synovitis in patients with juvenile idiopathic arthritis
* Intra-articular injection: Intra-articular steroid injections may lead to complete resolution of synovitis, particularly in children with oligoarthritis .
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