Juvenile idiopathic arthritis
Updates to Article Attributes
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis, is the most common chronic arthritic disease of childhood and has multiple subtypes.
Epidemiology
The estimated incidence is ~13 per 100,000 per annum 3. By definition, symptoms must start before 16 years of age. Females are more affected with F:M = 2:1.
Clinical presentation
Oligoarticular or polyarticular arthritis of a duration of six weeks or longer must be present to diagnose JIA.
Patients may present with an acute onset of symptoms or a more gradual onset. Symptoms are often worse in the morning, but typically persist to some extent throughout the day.
In patients with systemic onset also(also known as Still disease), intermittent spiking fevers are typically noted, which helphelps distinguish JIA from other diseases such as infection, other inflammatory diseases and malignancy. Migratory light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic onset.
Pathology
There are several subtypes of JIA 7,8:
-
oligoarticular JIA
- affected ≤4 joints in the first six months of illness
- peak age: 1-6 years
- mainly affects medium and large joints
-
polyarticular JIA
- ≥5 joints are affected
- peak age: 1-4 years; 7-10 years
- mainly affects small and medium joints
-
systemic onset JIA (a.k.a. Still disease)
- see above
- arthritis may occur weeks-to-months after onset of systemic symptoms
Radiographic features
Imaging shows a varied spectrum of involvement, based on the severity and duration of the disease.
Radiograph
Findings on x-ray include soft tissue swelling, osteopenia, loss of joint space, erosions, growth disturbances (epiphyseal overgrowth) and joint subluxation.
Hepatosplenomegaly may be seen on abdominal radiographs, and pericardial or pleural effusions may be seen on chest radiographs.
MRI
MRI shows synovial hypertrophy, joint effusions as well as osseous and cartilaginous erosions. Active synovitis is characterized by enhancement on T1-weighted gadolinium contrast studies.
-<p><strong>Juvenile idiopathic arthritis </strong>(<strong>JIA</strong>), also known as <strong>juvenile rheumatoid arthritis</strong>, is the most common chronic arthritic disease of childhood and has multiple subtypes.</p><h4>Epidemiology</h4><p>The estimated incidence is ~13 per 100,000 per annum <sup>3</sup>. By definition, symptoms must start before 16 years of age. Females are more affected with F:M = 2:1.</p><h4>Clinical presentation</h4><p>Oligoarticular or polyarticular arthritis of a duration of six weeks or longer must be present to diagnose JIA.</p><p>Patients may present with an acute onset of symptoms or a more gradual onset. Symptoms are often worse in the morning, but typically persist to some extent throughout the day.</p><p>In patients with systemic onset also known as<strong> Still disease</strong>, intermittent spiking fevers are typically noted, which help distinguish JIA from other diseases such as infection, other inflammatory diseases and malignancy. Migratory light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic onset.</p><h4>Radiographic features</h4><p>Imaging shows a varied spectrum of involvement, based on the severity and duration of the disease.</p><h5>Radiograph</h5><p>Findings on x-ray include soft tissue swelling, <a href="/articles/regional-osteopaenia">osteopenia</a>, loss of joint space, erosions, growth disturbances (epiphyseal overgrowth) and joint <a href="/articles/subluxation">subluxation</a>.</p><p><a href="/articles/hepatosplenomegaly">Hepatosplenomegaly</a> may be seen on abdominal radiographs, and <a href="/articles/pericardial-effusion">pericardial</a> or <a href="/articles/pleural-effusion">pleural effusions</a> may be seen on chest radiographs.</p><h5>MRI</h5><p>MRI shows synovial hypertrophy, <a href="/articles/joint-effusion">joint effusions</a> as well as osseous and cartilaginous erosions. Active synovitis is characterized by enhancement on T1-weighted gadolinium contrast studies.</p>- +<p><strong>Juvenile idiopathic arthritis </strong>(<strong>JIA</strong>), also known as <strong>juvenile rheumatoid arthritis</strong>, is the most common chronic arthritic disease of childhood and has multiple subtypes.</p><h4>Epidemiology</h4><p>The estimated incidence is ~13 per 100,000 per annum <sup>3</sup>. By definition, symptoms must start before 16 years of age. Females are more affected with F:M = 2:1.</p><h4>Clinical presentation</h4><p>Oligoarticular or polyarticular arthritis of a duration of six weeks or longer must be present to diagnose JIA.</p><p>Patients may present with an acute onset of symptoms or a more gradual onset. Symptoms are often worse in the morning, but typically persist to some extent throughout the day.</p><p>In patients with systemic onset (also known as<strong> Still disease</strong>), intermittent spiking fevers are typically noted, which helps distinguish JIA from other diseases such as infection, other inflammatory diseases and malignancy. Migratory light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic onset.</p><h4>Pathology</h4><p>There are several subtypes of JIA <sup>7,8:</sup></p><ul>
- +<li>
- +<strong>oligoarticular JIA</strong><ul>
- +<li>affected ≤4 joints in the first six months of illness</li>
- +<li>peak age: 1-6 years</li>
- +<li>mainly affects medium and large joints</li>
- +</ul>
- +</li>
- +<li>
- +<strong>polyarticular JIA</strong><ul>
- +<li>≥5 joints are affected</li>
- +<li>peak age: 1-4 years; 7-10 years</li>
- +<li>mainly affects small and medium joints</li>
- +</ul>
- +</li>
- +<li>
- +<strong>systemic onset JIA </strong>(a.k.a. Still disease)<ul>
- +<li>see above</li>
- +<li>arthritis may occur weeks-to-months after onset of systemic symptoms</li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic features</h4><p>Imaging shows a varied spectrum of involvement, based on the severity and duration of the disease.</p><h5>Radiograph</h5><p>Findings on x-ray include soft tissue swelling, <a href="/articles/regional-osteopaenia">osteopenia</a>, loss of joint space, erosions, growth disturbances (epiphyseal overgrowth) and joint <a href="/articles/subluxation">subluxation</a>.</p><p><a href="/articles/hepatosplenomegaly">Hepatosplenomegaly</a> may be seen on abdominal radiographs, and <a href="/articles/pericardial-effusion">pericardial</a> or <a href="/articles/pleural-effusion">pleural effusions</a> may be seen on chest radiographs.</p><h5>MRI</h5><p>MRI shows synovial hypertrophy, <a href="/articles/joint-effusion">joint effusions</a> as well as osseous and cartilaginous erosions. Active synovitis is characterized by enhancement on T1-weighted gadolinium contrast studies.</p>
References changed:
- 7. M. William Schwartz. The 5 Minute Pediatric Consult. (2012) ISBN: 9781451116564 - <a href="http://books.google.com/books?vid=ISBN9781451116564">Google Books</a>
- 8. Karen J. Marcdante, Robert M. Kliegman. Nelson Essentials of Pediatrics. (2014) ISBN: 9781455759804 - <a href="http://books.google.com/books?vid=ISBN9781455759804">Google Books</a>
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