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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