Tuesday, March 9, 2010

Juvenile idiopathic arthritis

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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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence