Juvenile idiopathic arthritis
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Juvenile idiopathic arthritis (JIA) is a term used to describe different types of arthritis that affect children under the age of 16 years. The International League of Associations for Rheumatology (ILAR) categorizes JIA into seven subtypes including systemic arthritis, oligoarthritis, polyarthritis, enthesitis-related arthritis, and psoriatic arthritis. Exclusions from the JIA diagnosis include conditions such as psoriasis, ankylosing spondylitis, inflammatory bowel disease, and rheumatoid factor positivity. Treatment of JIA involves the use of non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs like methotrexate
Juvenile idiopathic arthritis
- 3. ACR EULAR ILAR TERMS JRA JCA JIA AGE <16 YRS < 16 YRS < 16 YRS DURATION > 6 WKS > 3 M > 6 WK SUBTYPES 3 3 6 EXCLUSION ReA, Psoriatic RF positive polyarthritis ReA
- 4. JIA ILAR criteria" categories include: •Systemic arthritis •Polyarthritis •Oligoarthritis (persistent and extended) •Enthesitis-related arthritis •Psoriatic arthritis
- 7. Exclusions: A. Psoriasis or history of psoriasis in patients or first-degree relatives. B. Arthritis in HLA B27 positive males beginning after the age of 6 years. C. Ankylosing spondylitis, enthesitis-related arthritis, sacroiliitis with inflammatory bowel disease, Reiter's syndrome, acute anterior uveitis, or history of 1 of these disorders in first-degree relatives. D. Presence of IgM rheumatoid factor on at least 2 occasions at least 3 months apart. E. Presence of systemic JIA in patients.
- 8. SYSTEMIC •Arthritis WITH or PRECEDED by daily fever of atleast 2 wk duration with atleast one of thefollowing •Evanescent non fixed erythematous rash •Generalized LN •Hepatomegaly •Splenomegaly •Serositis
- 9. OLIGO •1-4 joints involvement during the first 6months of illness
- 10. POLY •>4 joints involved during the first 6 months Subtypes – •RF + •RF -
- 11. Psoriatic Psoriasis with arthritis OR Arthritis with any of the following 2 •Dactylitis •Pitting/onycholysis •Psoriasis in a 1st degree relative
- 12. Enthesitis related Arthritis + enthesitis OR Arthritis or enthesitis with any of the following 2 •H/O inflammatory back pain •HLA B27 + •Acute anterior uveitis •H/O Rea, IBD, acute anterior uvieits in 1st degree relative
- 13. DIFFERENTIAL DIAGNOSIS sJIA •Leukemia •Post infectious arthritis •Septic arthritis •SLE •Rheumatic fever •Kawasaki disease •Lyme disease •Osteomyelitis
- 14. TREATMENT OF JIA •ACR recomonded 5 groups for the treatment of JIA • History of arthritis 4 or fewer joints • History of arthritis in 5 or more joints • Active sacroiliac arthritis • Systemic arthritis with active systemic features(and without active arthritis) • Systemic arthritis wiyh active arthritis( and without active systemic features)
- 20. DRUGS • NSAIDs- NAPROXEN, IBUPROFEN,DICLOFENAC, INDOMETHACIN,CELECOXIB • SULPHASALAZINE • METHOTREXATE • STEROIDs- METHYLPREDNISOLONE, PREDNISONE • ADALIMUMAB • ETANERCEPT • ABADACEPT • ANAKINRA • TOCILIZUMAB • CANAKINUMAB