VCU DPT - Lifespan 1 (Juvenile Idiopathic Arthritis)

_____ is a group of conditions that present with arthritis of unknown etiology

- lasts for 6 weeks, onset before 16 years old

juvenile idiopathic arthritis

juvenile idiopathic arthritis (JIA) is a group of conditions with a ______ etiology

- lasts for __________ weeks

- onset occurs before ___________ years old

unknown

at least 6

16

jia is a diagnosis of ___________

exclusion

JIA causes joint __________ that can restrict a child's activities

swelling

what are acute cardinal signs of JIA (4)

swelling

end range stress pain

stiffness

loss of full ROM

__(acutely/chronically)__, patients with JIA have swelling and protective muscle spasms known as contraction defmorities

acute

acutely, patients with JIA experience swelling and protective muscle spasms known as _________

contraction deformities

what are 4 chronic signs of JIA

muscle atrophy and weakness

chronic inflammation

risk of fracture

postural abnormalities

________ is a chronic sign of JIA, in which there is higher production of synovial fluid that stretches and weakens the joint capsule

chronic inflammation

issue with chronic inflammation with JIA

the increased synovial fluid stretches and weakens the joint capsule

this leads to ligamentous laxity, overgrowth of synovium into articular cartilage, and loss of cartialge

Pt is 12yo girl who plays soccer. Has pain in L knee and R ankle 9 months ago. Stiffness in both of joints in morning that lasts until start of school at least. Stiffness is worst after periods of rest. Hrd time on stairs and is scared to play soccer/PE class because of leg pains

what are symptoms and signs linking us to JIA in this case

morning stiffness

different limbs, different areas

stiffness with rest

going up stairs and compressing joints

pain at least 16 weeks, is not yet 16 yo

what are 4 types of JIA

systemic arthritis

oligoarthritis

polyarthritis

enthesitis related arthritis

polyarthritis is one of the four types of JIA

what are the two types of polyarthritis

RF +

RF -

the onset of _______ is at _______:

systemic arthritis

throughut childhood

the onset of _______ is at _______:

oligoarthritis

early childhood, peak 2-4 years

the onset of _______ is at _______:

polyarthritis

late childhood/adolescence (biphasic)

early peak at 2-4 yo, later peak at 6-12yo

the onset of _______ is at _______:

enthesitis related arthritis

late childhood or adolescence

of the 4 types of JIA, which type is present more in males than females

enthesitis related arthritis

OTHERS FEMALES >>> MALES

diagnositic marker of oligoarthritis

low grade inflammation in four or fewer joints

most frequent joints of oligoarthritis

what joints usually not involved

knees > ankles > elbows

hips and small joints

t/f: you see systemic symptoms with oligoarthritis

t

may see iridocyclitis

diagnostic marker of polyarthritis (3)

five or more joints

within first 6 months of disease

swollen and warm joints

describe presentation of involved joints with polyarthritis

symmetrical bilaterally

both large and small joints

can include cervical/TMJ

systemic symptoms associated with polyarticular arthritis (3)

usually mild, low grade fever

20% see iridocyclitis

RF positive follows typical rheumtoid disease course to adults

t/f: polyarticular arthritis patients with RF positive follow typical rheumatoid disease course to adults

t

systemic arthritis diagnostic marker

systemic fever at 2 weeks AND rash on trunk/limbs

typical joints involved with systemic arthritis

typically symmetrical and polyarticular

- can be absent/develop later

systemic symptoms of systemic arthritis

rash****

Local inflammation in combination with joint pain, such as:

- pleuritis, pericarditis, myocarditis

- symmetrical lymphadenopathy

- spleen elargement

- serositis

ethesitis is inflammation where

entheses

tendon to bone insertion

ethesisis arthritis joints involved include

peripatellar enthesis

calcaneal enthesis

ethesitis has local T cells and innate immune cells that cause inflammtion in _____________ and subchondral bone marrow

tendons

___________ arthritis is a type of JIA with inflammation specifically at tendon insertion site

ethesitis

Pt is 12yo girl who plays soccer. Has pain in L knee and R ankle 9 months ago. Stiffness in both of joints in morning that lasts until start of school at least. Stiffness is worst after periods of rest. Hrd time on stairs and is scared to play soccer/PE class because of leg pains

in this case, what type is she likely presenting with and why

oligo

not bilateral presentation

no rash

not specified at tendon insertion

PT is _______ until JIA is controlled pharmacologically

limited

what are 4 main goals of pharmacological management with JIA

induce remissions (no more inflammation

control arthritis

prevent joint erosions

manage extra-articular manifestations

- fever, rash, vision changes

what is first line of pharm tx with JIA

NSAIDS

the following are _________ treatments for JIA:

NSAIDs

methotrexate (polyJIA and sJIA)

biologic medications (target tumor necrosis factor)

systemic glucorticosteroid (sJIA)

intraarticular injections of corticosteroids

pharmalogical

during PT exam of pt with JIA, why is history important

to understand the activity and participation restrictions

- can do through asking, outcomes (JADA)

understand child's pain perception

during PT exam, how do we assess strength

we do it through functional movements

observe for compensatory motor behavior

can we use goniometry for affected joints

yeah

what are some activity based outcomes we can do with patients with JJIA in PT exam

6MWT

standarized OMs

what is the main goal of acute interventions in pts with JIA

maintain and preserve joint fn

what are some modality like interventions/education we can give to pts with JIA in acute phase

heat therapy (warm showers, hydroptherapy)

parental massage

muscle relaxation and pain relief

- warm stuffed animal

why are we giving custom splints to children in acute phase of JIA

to protect and support joints

we do ___(active/passive)___ ROM in acute phase with JIA pts

actve

how do you do isometrics with JIA pts in acute phase

want them not prolonged or maximal contractions

but will help strengthen muscles and protect the joint, without moving it

what is the main goal of subacute/chronic phase of intervention with JIA patients

restoration and compensation

some interventions in the ________ phase include:

- strengthening

- moderate-vigorous exercise 2x/week

- assisting with preventing hypoactive lifestyle

- assess for AD needs

subacute/chronic

in strengthening during subacute/chronic phase of JIA, what are we doing

targeting mm supporting involved joints

dynamic exercises once joint inflammation is subsided

gravity resisted without pain --> add resistance

functional mobility related interventions in pts with JIA are to

promote age appropriate movements for bone growth and density, joint health, mm development

what shoe advice may you give to a JIA pt, related to functional mobility

cushioned, flexible, supportive, wide toe box

- can do custom orthoses or leg length lifts if needed

may patients with JIA need wheeled mobility for long distances?

potentially