Class 4: Juvenile Idiopathic Arthritis (JIA)

Possible causes of JIA

Immunogenic suscepitibility (genetic predisposition)

Environmental trigger (following infection)

Peak onset of JIA

1-3 years old

Almost every case occurs before 16 years old

Path review of JIA

Chronic inflammation of joint synovium and surrounding tissue

Increased synovial fluids leading to erosion and fribrosis of synovium

Has remision and exacerbation periods

Clinical manifestation of JIA

Joint enlargement (synovium buildup)

Joint stiffness (especially after waking up or during periods of inactivity)

Limited mobility in the affected joint (limping, bad sign)

Joint contractures, muscle wasting and growth disturbances (osteoporosis)

Warm and tender joints (erythema usually not present)

Fever 

Erythematous rash on trunk and extremities

Weight loss, fatigue and weakness 

Chronic and acute uveitis 

Enlargement of the liver, spleen, and lymph nodes.

Uveitis in JIA 

Inflammation of inner eye (1 or both eyes)

s+s: Eye pain/bleeding, blurry vision, photophobia, decreased vision, seeing spots (any symptoms means come to hospital asap)

Slit eye exam to determine (lifelong)

May need corticosteroid eye drops

How to check for enlargement of liver, spleen and lymph nodes in JIA 

Palpate abdomen 

JIA and rhemutoid factor

80% of people with JIA have positive rhemutoid factor 

Classification of JIA

Systemic onset (high fever, rash, hepatosplenomegaly, pericarditis, pleuritic, lymphadenopathy, serositis)

Oligoarthritic 

Polyartritic 

Psoriatic 

Enthesitis 

Undifferntiated 

Oligoarthritic JIA

Involves 4 or less joints for over 6 months

Polygoarthritic JIA

Involves 5 or more joints for at least 6 months

JIA: Enthesitis

Inflammation of a tendon

Diagnostic evaluation of JIA

No definitive tests, diagnosis of exclusion

Occurs before 16 years in 1 or more joints for 6 weeks or longer

CBC: Elevated WBC during periods of JIA exacerbation 

Elevated ESR and C reactive protein due to inflammation

Antinuclear antibodies (ANA) are common but also present in other auotimmune conditions or conditions targeting the immune system 

Slit eye exam to assess for uveitis

X rays 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.

Therapeutic management of JIA

No specific cure

Goals: control pain, preserve function, minimize effects of inflammation to prevent deformities, promote normal growth and development

WIll have OT and PT involved

Medications for JIA

Disease modifying antirhematic drugs (DMARDs) (methotrexate) 

Biological disease-modifying antirhematic drugs (Tumor necrosis factor antagonist)

NSAIDS (with DMARD/BMARD)

Corticosteroids (oral, injections into joints or may have eye drops for uveitis) (with DMARD/BMARD)

PT and OT

DMARDs and BMARDs 

DMARDs (methotrexate) are first line of defense for JIA 

Then BMARDs if that doesnt work

JIA corticosteroid considerations

Inject directly into affected joints

May need eye drops for uveitis 

Monitor for s+s of hyperglycemia 

Suppress immune response

Methotrexate dosing in JIA

10-15mg/meter squared of BSA/week PO/SQ

JIA Nursing care

Relieve pain (NSAIDs, dont commonly use opioids, warm compress/bath)

Splint joints at night to prevent contractures 

Promote general health 

Facilitating adherence 

Comfort measures and exercise 

Support child and family