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Juvenile Idiopathic Arthritis!

Symptoms

The most common signs and symptoms of juvenile rheumatoid arthritis are: --Pain. While your child might not complain of joint pain, you may notice that he or she limps — especially first thing in the morning or after a nap. --Swelling. Joint swelling is common but is often first noticed in larger joints like the knee. --Stiffness. You might notice that your child appears clumsier than usual, particularly in the morning or after naps. Juvenile rheumatoid arthritis can affect one joint or many. In some cases, juvenile rheumatoid arthritis affects the entire body — causing swollen lymph nodes, rashes and fever.Like other forms of arthritis, juvenile rheumatoid arthritis is characterized by times when symptoms flare up and times when symptoms disappear.

Epidemiology

The overall prevalence is estimated to be 1-2 per 1,000 children, with an incidence of 1 per 10,000.[2][3] It is more common in females, although there are differences depending on the subset. Juvenile rheumatoid arthritis occurs when the body's immune system attacks its own cells and tissues. It's unknown why this happens, but both heredity and environment seem to play a role. Certain gene mutations may make a person more susceptible to environmental factors — such as viruses — that may trigger the disease.

Classification

Undifferentiated arthritis (1-10%)

Enthesitis-related arthritis (2-10%)

Juvenile psoriatic arthritis (2-15%)

Systemic-onset JIA (5-10%)

Polyarticular JIA - RF positive (5%).

Polyarticular JIA - RF negative (25%).

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Oligoarticular JIA (50% of JIA)

Definition

joint inflammation presenting in children under the age of 16 years and persisting for at least six weeks, with other causes excluded.

Complications

Several serious complications can result from juvenile rheumatoid arthritis such as: --Eye problems: eye inflammation (uveitis) that may result in cataracts, glaucoma and even blindness. --Growth problems. Juvenile rheumatoid arthritis can interfere with your child's growth and bone development. Some medications used to treat juvenile rheumatoid arthritis, mainly corticosteroids, also can inhibit growth.

Differential diagnosis

-- Septic arthritis. -- Osteomyelitis. -- Reactive and post-infectious arthritis. -- Trauma. -- Mechanical pain. -- Pain syndromes. -- Inflammatory bowel disease. -- Malignancy. -- Connective tissue disease.

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Tests and diagnosis

Laboratory -- FBC: Normocytic anaemia. Normal or raised WBC with normal differential. Platelets mildly raised. -- ESR or CRP: often elevated. -- ANA, if positive, is associated with an increased risk of uveitis. -- RF and HLA B27 are useful for classification (HLA B27 is positive in 90% of enthesitis-related JIA). -- Viral or bacterial serology if history is suggestive of post-infectious arthritis. Imaging -- X-rays are normal in early JIA., It is useful to exclude trauma, osteomyelitis or malignancy. -- Ultrasound can show joint fluid , synovial hypertrophy and erosions if present. -- MRI delineates any bony changes, joint damage and extent of synovitis. Other Aspirate the joint if septic arthritis is suspected.

Managment

Lifestyle and home remedies -- Getting regular exercise. -- Applying cold or heat. -- Eating well. -- Adequate calcium in the diet

Medications -- Nonsteroidal anti-inflammatory drugs (NSAIDs). -- Disease-modifying antirheumatic drugs (DMARDs). -- Biologic agents. Also known as biologic response modifiers, including tumor necrosis factor (TNF) blockers. -- Corticosteroids.

Therapies - Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone. - A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child. - A therapist may also recommend that your child make use of joint supports or splints to help protect joints and keep them in a good functional position.