Juvenile Idiopathic Arthritis

Dr.Faust

non-infective, inflammatory joint disease that usually lasts over 6 weeks before 16 y.o.


1/1000


usually a diagnosis of exclusion


cause is unknown


more likely to be self-limited and non-deforming
more likely to have systemic manifestations, such as rash, high fevers, lymphadenopathy, hepatomegaly, mylagia, myocarditis, pericarditis, anterior uveitis (iridocyclitis esp.) and glomerulonephritis


the first sign of arthritis may be limping, especially in the morning, other signs similar to RA are also possible


less likely to have rheumatoid nodules
the morphologic joint pathology is similar to that of adult-onset RA.

rheumatoid factor negative (depending on subtype), ANA positive

Cases
A 14-year-old girl is brought to the clinic for leg pain.  She first noticed achiness in the ankles 3 months ago after starting a daily walking routine on a local trail to improve her health.  The aches tend to be worse in the morning but improve over the day.  The pain spread to the knees, elbows, and wrists over the past month.  Prior to this, the patient had been sedentary and spent most of her time indoors watching television.  In addition to the walking routine, she has transitioned to a plant-based diet.  The patient feels tired most days despite sleeping 9 hours a night.  Her weight has improved from the 95th percentile to the 90th percentile over the past 3 months, and her height is stable at the 75th percentile.  Temperature is 37.3 C (99.1 F), pulse is 80/min, and respirations are 16/min.  Cardiopulmonary examination is normal.  Bilateral ankles, knees, elbows, and wrists have mild swelling and tenderness to palpation.

Which of the following medications is most appropriate for this patient's condition?


A. ceftriaxone (3%)
B. Doxycycline (14%)
C. Levothyroxine (5%)
D. Naproxen (55% )

E. Vitamin D and calcium (20% )


Juvenile idiopathic arthritis (JIA), a chronic autoinflammatory condition, is the most common cause of arthritis in children.
Polyarticular JIA involves ≥ 5 joints within 6 months of disease onset. Polyarticular JIA is most commonly diagnosed in toddler and adolescent girls (ie, bimodal distribution).


Patients typically have joint pain and stiffness that is worse in the morning and improves over the course of the day.
Symmetric involvement of the elbows, wrists, knees, and ankles is most common.
In addition, swelling of the small joints of the hands and feet may be seen, particularly in older children.
Fever and other systemic symptoms (eg, rash) do not occur with polyarticular JIA.


Diagnosis is clinical.

First-line treatment is nonsteroidal anti-inflammatory drugs (eg, naproxen). Disease-modifying antirheumatic drugs such as methotrexate are also often required.


本题源于UW, 侵删