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Juvenile Idiopathic Arthritis - Coggle Diagram

- - - - Knee most common
      - NEVER hip
      - If small joint involvement - complex / evolving course
    - - Slightly ↑ ESR
      - Mild anaemia
  - - - Anterior synechia - adhesions of iris to cornea
      - Posterior synechiae - adhesion of iris to lense
- - - - Elevated ESR
      - Leukocytosis
  - - - Adolescent girls - disease course resembles adult RA
      - Poor prognosis
      - Joint deformities / erosions / nodules
      - Uveits less frequent, even if ANA+
- - - - Daily fever spikes - quotidian fever
        temp over 39 qd-bid with intercurrent return to baseline
      - Characteristically late in afternoon
      - Appear well generally, very ill appearing with fevers
    - - Evanescent salmon rash with fever
    - - Variable number of joints
      - Systemic illness may precede joint involvement
    - - Hepatosplenomegaly
      - Lymphadenopathy
      - Serositis
      - Anaemia, Transaminitis
      - Dramatic elevation of acute phase reactants
        ESR
        PLT
        EBC
      - ANA neg / RF neg
      - Often refractory to treatment - steroid dependent
      - IL-1 driven - classed with autoinflammatory disease (eg periodic fever syndromes)
      - MAS - Macrophage activation syndrome
  - - - More common in boys
      - High morbidity / mortality
      - Aetiology unknown
    - - NSAIDs
      - Gold
      - Abrupt medication changes
    - - Hepatic failure and Consumptive Coagulopathy / DIC
      - Anaemia, leukopenia, thrombocytopenia, Eleveted D-Dimers
      - Dramatic elevationof feritin, low fibrinogen
    - - Treat aggressively
      - Fresh frozen plasma
      - Pulse steroids
      - Cyclosporin
      - MTX
      - IL-1 blockade
- - - - Patella 2, 6, 10
        
        Attachment of pateller ligament to patella dn tibial tuberosity
        
        Insertion of quads into patella
      - Attachment of Achilles tendon to calcaneus
      - Insertion of plantar fascia into calcaneus
        Heads of 1st - 5th metatarsal
        Base of 5th metatarsal
  - - - Differentiation of SEA, ERA, JAS may be impossible in childhood
        Evolution over time
    - - Boys more often more aggressive
      - HLA-B27 (+) higher risk of progression to JAS
      - B27+ boys with elevated ESR at highest risj
      - B27(-) girls lowest risk
    - - Radiographic proof of Sacroiliitis - rare in kids
      - Few fill the full criteria
      - New York Criteria
      - Peripheral joit disease may precede axial involvement by years
      - Don't wait for filled criteria - TREAT
  - - - Maintain mobility
      - Splinting
      - Heel cups
  - - - Painful
        Erythematous
        Photophobic
- - - - RF+
      - Other form of JIA
- - - - “Can’t see, can’t pee, can’t climb a tree”
      - Conjunctivitis / uveitis
      - Urethritis
      - Arthritis
    - - Shigella
      - Salmonella
      - Yersinia
      - Campylobacter
      - GC / Chlamydia
    - - Very rare in IRE population
  - - - Noctural pain - gone in the morning
      - Pain in knees / calves
      - Normal Labs
    - - Rubbing
      - NSAIDS
      - Bathing
  - - - Classically Post Srep
      - Polyarticular
      - Not migratory
      - No cardiac findings
      - Elevated ESR
      - Settles in <6 weeks, can last 6 months
    - - Strep
      - EBV
      - CMV
      - Parvo
      - HSV
      - VZV
      - Hep B
- - - - Traditional gold standard in severe JA
      - 60% repsond
      - Remission in 50% in 1yr
  - - - Side effects unacceptable for long term use
      - Risk of growth distrubances
    - - Used in pauci-articualr as 1st line
  - - - Etanercept (Enbrel)
      - Adalimumab (Humira)
      - Infliximab (Remicade)
    - - Abatacept (Orencia)
        Rarely used
    - - Tocilizumab
    - - Anakinra
    - - Rituximab (Rituxan)