Juvenile Rheumatoid Arthritis ⇒ The four criteria listed by the American Rheumatism Association for diagnosing juvenile rheumatoid arthritis (JRA)
(1) chronic synovial inflammation of unknown cause,
(2) onset in children younger than 16 years,
(3) objective evidence of arthritis in one or more joints for 6 consecutive weeks, and
(4) exclusion of other diseases.
The three categories of Juvenile Rheumatoid Arthritis include pauciarticular, polyarticular, and systemic.
Pauciarticular Juvenile Rheumatoid Arthritis ➤ involves 4 or fever joints after 6 months of symptoms
polyarticular Juvenile Rheumatoid Arthritis ➤ involves 5 or more joints.
Systemic Juvenile Rheumatoid Arthritis ➤ is characterized by an illness that begins with high, spiking fevers and is likely to be complicated by pericarditis, pleural effusions, and enlargement of the liver, spleen, and lymph nodes.
➽Pauciarticular Juvenile Rheumatoid Arthritis is the most common pattern and is characterized by onset before 4 years of age and a female-to-male ratio of 4:1. Pain, swelling, and stiffness are strikingly less severe at disease onset in pauciarticular Juvenile Rheumatoid Arthritis compared with adult Rheumatoid Arthritis.
Parents typically note some morning stiffness and reluctance of the child to actively play. The disease start in a single joint, most frequently the knee, ankle, wrist, or finger joints.
➽Polyarticular Juvenile Rheumatoid Arthritis is characterized by symmetric involvement of the knees, wrists, fingers, and ankles, and it is more common in girls.
The onset of seronegative polyarticular Juvenile Rheumatoid Arthritis occurs typically between the ages of 1 and 3 years. The seropositive form usually begins in adolescence and is virtually indistinguishable from adult Rheumatoid Arthritis.
➽Systemic Juvenile Rheumatoid Arthritis accounts for approximately 10% of all cases. Onset commonly is noted between 4 and 9 years of age. At onset, patients appear systemically ill and have daily, or even twice-daily, spiking fevers that are often accompanied by a characteristic salmon-pink evanescent rash .
Iridocyclitis (inflammation of the anterior uveal tract) is most likely to develop in pauciarticular Juvenile Rheumatoid Arthritis, occurring in 75% of those patients who also have a positive antinuclear antibody (ANA) test.
Most commonly, iridocyclitis begins shortly after joint involvement, but it may develop before joint involvement or as late as 10 years after the onset of joint symptoms. The condition is usually chronic and insidious, and it may result in serious damage to the eye, including synechiae with resultant irregular pupil, band keratopathy with obstructed vision, and secondary cataracts .
Because these children rarely complain of symptoms, early detection is dependent on timely and ongoing slit lamp examinations by ophthalmologists. The diagnosis of Juvenile Rheumatoid Arthritis is one of exclusion. No diagnostic tests are available, and even the erythrocyte sedimentation rate is often normal in children with pauciarticular and polyarticular Juvenile Rheumatoid Arthritis. The differential diagnosis includes leukemia, osteomyelitis, and septic arthritis.
Leukemia is associated with night pain and with pain that is associated more with the bone than the joint. Osteomyelitis presents with fever and more severe pain.
Septic arthritis is characterized by single-joint involvement, severe pain, and fever. Spontaneous remission is common, but endstage arthritis may occur, particularly in patients with systemic and late-onset polyarticular disease.
Treatment begins with NSAIDs. Other medications, such as methotrexate, are used if synovitis is persistent. Surgical intervention is used primarily to treat end-stage destructive arthritis.
(2) onset in children younger than 16 years,
(3) objective evidence of arthritis in one or more joints for 6 consecutive weeks, and
(4) exclusion of other diseases.
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Pauciarticular Juvenile Rheumatoid Arthritis ➤ involves 4 or fever joints after 6 months of symptoms
polyarticular Juvenile Rheumatoid Arthritis ➤ involves 5 or more joints.
Systemic Juvenile Rheumatoid Arthritis ➤ is characterized by an illness that begins with high, spiking fevers and is likely to be complicated by pericarditis, pleural effusions, and enlargement of the liver, spleen, and lymph nodes.
➽Pauciarticular Juvenile Rheumatoid Arthritis is the most common pattern and is characterized by onset before 4 years of age and a female-to-male ratio of 4:1. Pain, swelling, and stiffness are strikingly less severe at disease onset in pauciarticular Juvenile Rheumatoid Arthritis compared with adult Rheumatoid Arthritis.
Parents typically note some morning stiffness and reluctance of the child to actively play. The disease start in a single joint, most frequently the knee, ankle, wrist, or finger joints.
➽Polyarticular Juvenile Rheumatoid Arthritis is characterized by symmetric involvement of the knees, wrists, fingers, and ankles, and it is more common in girls.
The onset of seronegative polyarticular Juvenile Rheumatoid Arthritis occurs typically between the ages of 1 and 3 years. The seropositive form usually begins in adolescence and is virtually indistinguishable from adult Rheumatoid Arthritis.
➽Systemic Juvenile Rheumatoid Arthritis accounts for approximately 10% of all cases. Onset commonly is noted between 4 and 9 years of age. At onset, patients appear systemically ill and have daily, or even twice-daily, spiking fevers that are often accompanied by a characteristic salmon-pink evanescent rash .
Iridocyclitis (inflammation of the anterior uveal tract) is most likely to develop in pauciarticular Juvenile Rheumatoid Arthritis, occurring in 75% of those patients who also have a positive antinuclear antibody (ANA) test.
Most commonly, iridocyclitis begins shortly after joint involvement, but it may develop before joint involvement or as late as 10 years after the onset of joint symptoms. The condition is usually chronic and insidious, and it may result in serious damage to the eye, including synechiae with resultant irregular pupil, band keratopathy with obstructed vision, and secondary cataracts .
Because these children rarely complain of symptoms, early detection is dependent on timely and ongoing slit lamp examinations by ophthalmologists. The diagnosis of Juvenile Rheumatoid Arthritis is one of exclusion. No diagnostic tests are available, and even the erythrocyte sedimentation rate is often normal in children with pauciarticular and polyarticular Juvenile Rheumatoid Arthritis. The differential diagnosis includes leukemia, osteomyelitis, and septic arthritis.
Leukemia is associated with night pain and with pain that is associated more with the bone than the joint. Osteomyelitis presents with fever and more severe pain.
Septic arthritis is characterized by single-joint involvement, severe pain, and fever. Spontaneous remission is common, but endstage arthritis may occur, particularly in patients with systemic and late-onset polyarticular disease.
Treatment begins with NSAIDs. Other medications, such as methotrexate, are used if synovitis is persistent. Surgical intervention is used primarily to treat end-stage destructive arthritis.
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