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Juvenile Idiopathic Arthritis: Diagnosis, Treatment & Management

Pediatric chronic arthritis characterized by joint pain and inflammation in subtypes like polyarticular, pauciarticular, and systemic JIA. Pathophysiology involves immune system and TNF-α, IL-6 and IL-1. Diagnosis includes labs, imaging, and physical exams to identify joint involvement and other causes. Treatment involves medications like NSAIDs, DMARDs, methotrexate, Etanercept, Adalimumab, and intra-articular glucocorticoids for inflamed joints, with conservative and medical approaches. Prognosis can be negative with early hip or wrist involvement and presence of rheumatoid factor.

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Juvenile Idiopathic Arthritis: Diagnosis, Treatment & Management

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  1. Juvenile idiopathic arthritis By: Brittni McClellan

  2. Juvenile idiopathic arthritis- description • Description: • Broad Term • Pediatric Chronic Arthritis • Characterized by Joint Pain and Inflammation • Diagnostic Criteria: • 1 or more joints involved • At least 6 weeks • < 16 years old • Subtypes  • Polyarticular Juvenile Idiopathic Arthritis (JIA)  • ≥ 5 joints involved • Pauciarticular JIA  • 1-4 joints involved • Systemic JIA  • Visceral Involvement

  3. Juvenile idiopathic arthritis - Pathophysiology • Not Well Understood • Humoral and Cell-Mediated Immune System Involved • T-Cells: Release TNF-α, IL-6,, and IL-1 • Humoral: Increase ANA Production, Immunoglobulins, and Immune Complexes • Prognosis: • Negative  • Early Hip or Wrist Involvement • Presence of Rheumatoid Factor

  4. Juvenile idiopathic arthritis – H&P • Patient History: • Fever • Quotidian Pattern • 1-2x/day, Eventually Subside • Morning Stiffness • Joint Pain • Joint Stiffness • Especially with periods of inactivity • Visual Changes • Uveitis

  5. Juvenile idiopathic arthritis – H&P Physical Exam: • Joint Involvement • Swelling • Limited Range of Motion • Tenderness to Palpation • Uveitis • Slit Lamp • Visceral Involvement (Systemic JIA):  • Evanescent and Salmon-Colored Macular Rash • Hepatosplenomegaly • Serositis  • Pleural/Pericardial effusion

  6. Juvenile idiopathic arthritis - Diagnosis Diagnosis: • Imaging: • Radiography: performed if only 1 joint is involved in order to evaluate for other causes (Osteomyelitis) • Labs: • ↑ (CRP) and (ESR)  • Positive ANA 

  7. Juvenile idiopathic arthritis – treatment • Medication • Conservative  • Periodic Ophthalmologic Exams – Slit Lamp - Uveitis • Medical  • NSAIDs – Symptomatic Relief • DMARD – Anti-Inflammatory • Methotrexate • Etanercept • Adalimumab • Intra-Articular Glucocorticoids • Management of Inflamed Joint

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