Juvenile Idiopathic Arthritis (JIA)

Juvenile idiopathic arthritis (JIA) is also called:

Juvenile Rheumatoid Arthritis

What is JIA? (2)

• Chronic childhood arthritis

• A group of heterogeneous autoimmune disease causing inflammation of the joint synovium

Possible causes of JIA

• Immunogenic susceptibility

• Environmental or external trigger (such as a virus)

Peak onset of JIA

1 - 3 years of age

JIA starts before what age?

16 years

JIA Pathophysiology

Chronic inflammation of the joint synovium and surrounding tissue.

Is the outcome of JIA predictable?

No! It is variable and unpredictable

JIA Clinical manifestations (9)

• Joint enlargement.

• Stiffness in joints, particularly on rising in the morning or during periods of inactivity.

• Limited mobility in affected joints. May limp when walking.

• May experience joint contractures, muscle wasting, and growth disturbances in the nearby structures, e.g. osteoporosis.

• Warm joints that may be tender when touched. Erythema usually not present Fever.

• Erythematous rash on the trunk and extremities.

• Constitutional symptoms include weight loss, fatigue, and weakness.

• Chronic and acute uveitis

• Enlargement of the liver, spleen, and lymph nodes.

Uveitis

inflammation of the anterior chamber of the eye can lead to permanent vision loss without prompt medical intervention.

Classification of Juvenile Idiopathic Arthritis: (6)

• JIA is a heterogeneous group of diseases

  • Systemic

  • Oligoarthritic

  • Polyarthritis

  • Psoriatic

  • Enthesitis

  • Undifferentiated

Systemic arthritis

• 20% incidence

• arthritis in one or more joints

• associated with at least 2 weeks of fever, rash, lymphadenopathy, hepatosplenomegaly, and serositis.

Serositis (3)

Inflammation of a serous membrane

• pericarditis

• pleuritis

• Peritonitis

Oligoarthritic (3)

• 50% incidence

• arthritis in ≤4 joints for the first 6 months of disease.

• It is subdivided to persistent oligoarthritis if it remains in ≤4 joints, and becomes extended oligoarthritis if it involves ≥5 joints after 6 months.

Polyarthritis (3)

• 30 % incidence

• involves ≥5 joints in the first 6 months.

• These children may be either rheumatoid factor negative or positive.

Psoriatic

arthritis with psoriasis

Enthesitis related arthritis

is arthritis, enthesitis (inflammation at the tendon insertion site),

Diagnostic evaluation (7)

• No definitive diagnostic tests; diagnosis of exclusion.

• Occurs before 16 years, arthritis in one or more joints for 6 weeks or longer, and exclusion of other causes.

• ↑ WBC on CBC during periods of exacerbation.

• Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein may be ↑ due to inflammation.

• Antinuclear Antibodies (ANA) are common in JIA but are present in other autoimmune conditions

• Slit eye exam

• X-ray

Why do a slit eye exam?

To assess for uveitis

What will an X-ray show? (2)

• X-rays of affected joints will show soft tissue swelling, widening of the joint spaces, and increased synovial fluid.

• X-rays taken later in the disease process may show osteoporosis, narrowing of the joint space, erosion, subluxation (displacement of bones from joints), and fusion of bones.

JIA Therapeutic management (3)

• No specific cure

• Physiotherapy

• Occupational therapy

Goals of therapy (4)

• control pain

• preserve function

• minimize effects of inflammation to prevent deformities

• promote normal growth and development

Medications for JIA (4)

• Disease-modifying antirheumatic drugs (DMARDs): Methotrexate 

• Biological disease-modifying antirheumatic drugs.

• Nonsteroidal anti-inflammatory drugs (NSAIDS).

• Corticosteroids.

Initial medication therapy

Disease-modifying antirheumatic drugs (DMARDs): Methotrexate 

Nursing care (5)

• Relieving pain.

• Promoting general health.

• Facilitating adherence.

• Comfort measures and exercise.

• Supporting the child and family.