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Paediatrics: Juvenile idiopathic arthritis

JIA is a common chronic childhood disorder (UK prevalence 1/1000; inci-dence: 1/10 000).

Juvenile idiopathic arthritis

 

JIA is a common chronic childhood disorder (UK prevalence 1/1000; inci-dence: 1/10 000). It is a diagnosis of exclusion in children <16yrs old with a history of at least 6wks of persistent arthritis. JIA is divided into 7 subsets for research purposes.1 These are not diagnostic categories, but are useful clinical groups. As a child’s symptoms evolve with time (e.g. the appear-ance of a psoriatic rash), they may change subtype.

 

Classification of JIA1

   Systemic arthritis: relative frequency,10–13%.

   Oligoarthritis (persistent or extended): relative frequency, 40%.

   Polyarthritis (rheumatoid factor +ve): relative frequency, 3%.

   Polyarthritis (rheumatoid factor –ve): relative frequency, 27%.

   Psoriatic arthritis: relative frequency, 2–15%.

   Enthesitis-related arthritis: relative frequency, 1–7%.

   Undifferentiated arthritis: relative frequency, 2–15%.

 

Differential diagnoses of childhood arthritis

 

   Infection:

   bacterial—septic arthritis; osteomyelitis

   viral—rubella; parvovirus B19; infectious mononucleosis;

   Lyme, Brucella, TB.

   Post-infection:

   reactive arthritis;

   post-streptococcal reactive arthritis;

   rheumatic fever.

   Malignancy:

   leukaemia;

   neuroblastoma;

   p bone tumours—benign or malignant;

   metastatic disease.

Orthopaedic:

   Perthes and other osteochondritides;

   slipped upper femoral epiphysis;

   hip dysplasia;

   infantile coxa vara;

   chondromalacia patellae;

   irritable hip.

   Hypermobility:

   benign hypermobility—local or generalized;

   Marfans, Ehlers–Danlos;

IBD.

·Connective tissue disease:

 

   SLE;

   juvenile dermatomyositis;

   systemic sclerosis—limited or progressive.

Metabolic disorders:

   gout;

   mucopolysaccharidoses.

Haematological:

   SCD;

   other haemoglobinopathies;

   haemophilia.

Vasculitis:

   HSP;

   polyarteritis/microscopic polyangitis

   Kawasaki disease;

   Takayasu arteritis.

Immunodeficiency syndromes.

Other inflammatory disorders:

   sarcoid;

   chronic recurrent multifocal osteomyelitis;

   SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis).

Idiopathic pain syndromes:

   chronic regional pain syndromes;

   fibromyalgia

‘non-organic pain’—a cry for help.

 

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Paediatrics: Bones and joints


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