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Chapter: Paediatrics: Bones and joints

Paediatrics: Oligoarticular juvenile idiopathic arthritis

Commonest subtype (previously known as pauciarticular JCA/JRA). 40% of patients.

Oligoarticular juvenile idiopathic arthritis

 

Commonest subtype (previously known as pauciarticular JCA/JRA). 40% of patients.

Two subsets are recognized: persistent and extended. If the number of joints increases to more than 4 within the first 6mths of illness, it is termed extended oligoarticular JIA.

 

Children may develop silent, blinding iritis (anterior uvertis). It is usually ANA-positive patients (40–75% of this form of illness) who are at risk of developing iritis.

 

Clinical features

 

Diagnosis of exclusion; rule out infection.

Milder symptoms than reactive arthritis; no constitutional symptoms.

Often present with joint swelling or limping rather than pain.

2/3 single joint; 1/3 only 2 joints; often asymmetrical; knees, ankles, elbows, wrists common, but any joint possible.

Careful examination may reveal more extensive disease as the child may be too young to express pain.

Elbows and knees may lack full extension, but not be painful.

Affected leg may overgrow; measure leg lengths and check pelvis is level.

Observe gait for circumduction to compensate for limb overgrowth.

 

Investigations

 

FBC; CRP (usually normal); ANA (prognostic value for uveitis).

 

X-ray: exclude fracture, tumour; look for overgrowth and damage.

 

Management

 

Regular review to assess joints, eyes, and general growth.

NSAIDs for pain and stiffness: full dose for 8wks (ibuprofen, diclofenac, naproxen, or piroxicam).

Intra-articular steroid injections: may settle inflammation for years.

If not controlled with oral NSAIDs and intra-articular steroids, MTX oral or SC is used in resistant cases.

Rarely etanercept (anti-TNF therapy) is needed.

Screen for uveitis: initially 3-monthly, by ophthalmologist.

 

Disease course and prognosis

 

80% normal at 15yrs. ‘Extended’ subset have worse prognosis.

 

Uveitis is most important extra-articular complication.

 

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Paediatrics: Bones and joints : Paediatrics: Oligoarticular juvenile idiopathic arthritis |

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Paediatrics: Bones and joints


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