1. JUVENILE IDIOPATHIC
ARTHRITIS
Dr Muthoka

2. • Jia is a preferred term for non-infective inflammatory jt disease of
more tha 3 months duration children under 16 yrs
• It embraces a group of disorders affecting a few of the larger joints-
about 10% present with particular arthritis
• Sometimes closely resemble r.a-5-10 % can develop seronegative
polyarthritis

3. SYSTEMIC JIA
• This is the classic stills dx, is usually seen below the age of 3 yrs
• Affect boys and girls equally
• Start with intermittent fever ,rash & malaise
• During these episodes which occur almost daily the of appear quite ill
but a few hours later the clinical condition improve again
• Less constant features are lymphadeopathy, splenomegaly &
hepatosplenomegaly
• It swelling occur some weeks or months after the onset
• It usually resolves when the systemic illness subsides

4. • But it may go on progressive seronegative polyarthritis; leading to
permanent deformity of the large joints
• By puberty there may be stunting of growth, often abetted by earlier
use of corticosteroids

5. Pauciarticular jia
• This is by far the commonest form of his
• Usually occur below the age of 6 yrs
• Is much more common in girls
• Occasionally older children are affected
• Only a few joints are involved
• There is no systemic illness
• Present with a pin &swelling of medium sized jts; knee,ankle,elbow&
wrist
• Sometime only 1 it is affected.

6. • Th factor is negative but ANA positive
• Complications
• Chronic iridocyclitisin about 50% of pts
• The arthritis goes into remission after a few yrs but the child is left
with assymetrical deformities and growth defect may be permanent

7. POLYARTICULAR JIA
• Typically with involvement of the tempiromandibular joint & the
cervical spine.
• Usually seen in older children mainly girls
• The hands & wrist are often affected but the classic deformities of rh
arthritis are uncommon & th factor is usually absent
• In some cases the condition is indistinguishable from adult th
arthritiswith a +ve th factor& is called JUVENILE rheumatoid arthritis

8. Seronegative spondyloarthropathy
• In older children, usually boys;the condition may the form of
sacroiliitis& spondylitis
• Hips and knees are sometimes involved as well
• HLA B27is positive
• JUVENILE ankylosing spondylitis.

9. Xray
• Early- soft tx swelling
• Late-progressive joint erosion & deformity

10. Ixs
• Fhg-increase in bbc and eat
• Rh factor test are +ve in jra
• Jt aspiration& fluid examination to exclude infection or hemarthrosis
• DIAGNOSIS
• EARLY stages diagnosis is difficult
• Start like viral infection

11. Ddx
• Pauciarticular
• Reiters dx &
• Septic arthritis acute
• Tb synovitis chronic
• Rh fever
• Bleeding disorder
• Leukaemia
• When pattern of it involvement is established diagnosis become clear
• May require
• Blood ix, it aspiration, synovial biopsy.

12. Rx
• Systemic dx is similar to that of rh arthritis
• Hydrochlorquine
• Sulfasalazine
• Methotrexate
• Corticosteroids used only for severe systemic dx
• & for chronic iridicyclitis unresponsive to topical therapy
• Severe inflammatory dx may need to betrayed with cytokine
inhibitors such as anti tend therapies.

13. LOCAL RX
• Priorities are to.prevent stiffness &dx
• Night splints may be useful for wrists, hand, knees,& ankle
• Prone lying for some period each day may prevent flexion
contracturesof hip
• Exercise & physiotherapy
• Fixed deformity may need correction by serial plaster
• Jt capsuloromy
• Custom designed arthroplasties of hip& knee.
• Arthrodesis of the wrist or ankle

14. Complications
• Ankylosis-loss of it not
• Growth defects; corticosteroids use/epiphyseal disturbance
• Fractures –osteoporosis
• Iridoxyclitis- ANA +ve . Untreated may lead to blindness
• Amyloidosis
• PROGNOSIS
• Most children left with only moderate deformity& limitation of fxn
• 5-10%are severely crippled & require rx through out life
• 3% die of renal failure due to amyloidosis.