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Chapter: Medicine Study Notes : Musculo-Skeletal

Juvenile Rheumatoid Arthritis

Arthritis beginning at or before 16 years of age (usually early childhood)

Juvenile Rheumatoid Arthritis

 

·        = Arthritis beginning at or before 16 years of age (usually early childhood)

·        = Still‟s Disease 

·        Signs: High, swinging, early evening fever, pink maculo-papular rash, arthralgia, arthritis, myalgia, generalised lymphadenopathy

·        Number of different types: 

o  Oligoarthritis (persistent): asymmetrical, affecting 4 or fewer joints, especially wrist, knees, ankles. Usually remission in 4 – 5 years

o  Oligoarthritis (extended): Oligoarticular onset progressing to > 4 joints 

o  Polyarticular JCA: Usually in teenagers progressing to widespread joint destruction, especially hands (less so the DIPs)

o   Extra-articular involvement can include: pericarditis, myocarditis, pulmonary fibrosis, glomerulonephritis, uveitis and growth retardation

·        Differences from Adult RA:

o   Oligoarthritis is more common

o   Systemic onset is more frequent

o   Large joints affected more than small joints

o   Rheumatoid nodules and rheumatoid factor are usually absent

o   ANAs often positive

·        Treatment:

o   Referral to specialist

o   Low dose NSAIDs/paracetamol (Aspirin: beware of Reyes Syndrome)

o   Corticosteroids

·        Prognosis: variable: up to 50% have long term disability 

·        Completely different disease entity to Juvenile Spondyloarthropathies – although clinically may overlap. Enthesitis common

 

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Medicine Study Notes : Musculo-Skeletal : Juvenile Rheumatoid Arthritis |


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