4.1 - juvenile idiopathic arthritis

6 weeks; BEFORE 16 years

juvenile idiopathic arthritis (JIA) is a group of conditions that present with arthritis of an unknown etiology lasting for at least __________ with an onset of _________

Juvenile idiopathic arthritis

________________ causes joint swelling that can significantly restrict a child’s activities

unknown

what is the etiology of juvenile idiopathic arthritis

F (after 16 years, no longer called JIA)

T/F: if a child has JIA, it is still considered JIA in early adulthood

exclusion

JIA is diagnosis based on ______________

• swelling

• end range stress pain

• stiffness

• loss of full ROM

4 cardinal signs of inflammation

contraction deformities

swelling and protective muscle spasms are known as _____________

synovial fluid

during chronic inflammation, there is an increased production of ____________ which stretches and weakness the joint capsule

chronic

demineralization occurs with acute or chronic inflammation

• systemic arthritis

• oligoarthritis **most common

• polyarthritis

• enthesitis related arthritis

what are the 4 most common types of JIA?

which is the most common?

throughout childhood

when is the onset of systemic arthritis?

early childhood, peak at 2-4 years

when is the onset of oligoarthritis?

females

is systemic arthritis more common in females or males

females

is oligoarthritis more common in females or males

• late childhood or adolescence

• biphasic distribution:

  • early peak at 2-4 yo

  • later peak at 6-12 yo

when is the onset of polyarthritis?

females

is polyarthritis more common in females or males

oligoarthritis

which type of JIA is most prevalent in females/female dominated

late childhood or adolescence

when is the onset of enthesitis related arthritis?

males

is enthesitis related arthritis more common in females or males

low grade inflammation in 4 or fewer joints

what is the diagnostic marker for oligoarthritis?

knee > ankles > elbows

what are the most frequent joints affected by oligoarthritis, IN ORDER

F (not common, but occasionally they can show iridocyclitis - eye swelling)

T/F: it is common for someone with oligoarthritis to show systemic symptoms

5 or more joint involvement

what is the diagnostic marker for polyarticular arthritis?

6 months

you should be able to diagnose polyarticular arthritis within the first __________ of the disease

T (usually mild-low grade fever, iridocyclitis, RF+ follows rheumatoid disease)

T/F: it is common for someone with polyarticular arthritis to show systemic symptoms

• symmetrical

• bilateral

• both small and large joints

polyarticular arthritis:

• symmetrical or asymmetrical

• unilateral or bilateral

• small or large joints

• systemic fever for at least 2 weeks

• rash on trunk and limbs

what is the diagnostic marker for systemic arthritis?

symmetrical; polyarticular

the joints in systemic arthritis are typically (symmetrical or asymmetrical) and _______________

enthesis

____________ is the tendon to bone insertion site

enthesitis

_____________ is a type of JIA where local T cells and innate immune cells cause inflammation in tendons and subchondral bone marrow

• peripatellar

• calcaneal

what are the two common joints that are involved with enthesitis

pharmacologically

the benefits of physical therapy will be limited until JIA is controlled ______________

• induce remissions

• control arthritis

• prevent joint erosions

• manage extra-articular manifestations

what are the 4 main goals of pharmacological management of JIA

NSAIDs

____________ medication is the first line of therapy for JIA

methotrexate (MTX)

____________ medication is used to manage both polyarthritis and systemic arthritis

biologic

_____________ medications target tumor necrosis factor, a cytokine responsible for many effects of inflammation

corticosteroids

intra-articular injections of long-acting ______________ treat severely inflamed and swollen joints

F (steroids CAN decrease the inflammation but DOES NOT alter the disease process)

T/F: the use of steroid treatment for JIA can help decrease the inflammation and alter the disease process

systemic steroids are a last resort bc they can impact growth and bone density, intra-articular injections have the benefits without the systemic risks

what is the benefit of using intra-articular injections over systemic steroids

Juvenile Arthritis Disease Activity Score (JADAS)

________________ is a measuring tool to assess the activity in Juvenile Idiopathic Arthritis (JIA).

6 minute walk test

what would an activity based outcome measure be for JIA

acute

the main goal of (acute, subacute, or chronic):

Maintain and preserve joint function

T (Don’t want to push a joint that is actively inflamed, don’t want to injure them furth, that’s why splints/casting is used)

T/F: during the acute phase of JIA, you should do AROM but NOT PROM

acute

intervention for (acute, subacute, or chronic):

muscle relaxation and pain relief

acute

intervention for (acute, subacute, or chronic):

isometric exercise, but not prolonged

acute

intervention for (acute, subacute, or chronic):

custom splints to support joints

acute

intervention for (acute, subacute, or chronic):

heat therapy

subacute and chronic

the main goal of (acute, subacute, or chronic):

restoration and compensation

subacute or chronic

intervention for (acute, subacute, or chronic):

strengthening

subacute or chronic

intervention for (acute, subacute, or chronic):

assist with preventing hypoactive lifestyle

mod-vig 2x/week for 45-60min

what is the exercise recommendation for subacute/chronic JIA