Download - Juveline Arthritis

7/29/2019 Juveline Arthritis

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About The Author

Dr Manoj R. kandoi is the founder president of Institute of Arthritis Care & Prevention

an NGO involved in the field of patient education regarding arthritis. Besides providingliterature to patient & conducting symposiums, the institute is also engaged in creating

patients Self Help Group at every district level. The institute also conducts a certificate

course for healthcare professionals & provide fellowship to experts in the field ofarthritis.The author has many publications to his credit in various journals. He has also written a

book The Basics Of Arthritis for healthcare professionals.

The author can be contacted at:Dr manoj R. kandoi

C-202/203 Navare Arcade

Shiv Mandir Road, Opposite Dena Bank

Shiv mandir Road, Opposite Dena bankShivaji Chawk, Ambarnath(E) Dist: Thane Pin:421501

State: Maharashtra Ph: (0251)2602404 Country: India

Membership Application forms of the IACR for patients & healthcare professionalscan be obtained from.

Institute of Arthritis Care & Prevention

C/o Ashirwad HospitalAlmas mension, SVP Road, New Colony,

Ambarnath(W) Pin:421501 Dist: Thane

State: Maharashtra Country: IndiaPh: (0251) 2681457 Fax: (0251)2680020

Mobile ;9822031683

Email:[email protected]

Preface:

Studies have shown that people who are well informed & participate actively in

their own care experience less pain & make fewer visits to the doctor than do otherpeople with arthritis. Unfortunately in India & many third world countries we do not

have patient education & arthritis self management programs as well as support groups.

This is an attempt to give a brief account of various arthritis, their prevention & selfmanagement methods which can serve as useful guide to the patients of arthritis.

It would be gratifying if the sufferers of the disease knew most of what is given in the

book.

Acknowledgement\

I am thankful to Dr (Mrs) Sangita Kandoi for her immense help in proofreading & for her

invaluable suggestions. The help rendered by Nisha Jaiswal is probably unrivalled.

Thanks also to vidya, sheetal and parvati for their continous support throughout themaking of the book. The author is grateful to his family for the constant inspiration they

offered. The author alone is responsible for the shortcoming in this piece of work. He

welcomes suggestions for improvement from the readers.
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Juveline Arthritis

Introduction:Juvenile arthritis may be acute or chronic in nature. Under the EULAR criteria, arthritis is

considered chronic if it is at least 3 months in duration.

Causes of acute onset Juvenile arthritis:

1. Infections:a. Bacterial: staphylococcus Streptococcus Tuberculousb. Viral

Rubella HIV Mumps Epstein barf virusesc. Others

Mycoplasma2. Reactive

a. Rheumatic feverb. Postvaccinationc. Hepatitis Bd. Lyme diseasee. Postsreptococcal arthritisf. Transient synovitis

3. Neoplastic

a. Leukemia and other malignanciesb. Hemolytic anaemiac. Neuro blastomad. Familial mediterrean fevere. Metastasis

4. Vasculitis

5. Juvenile rheumatoid arthritis6. Hemophilia

Causes of chronic arthritis in children:

1. Idiopathic childhood arthritis (Juvenile rheumatoid arthritis):

It may bea. Oligoarticular onset JRAb. Polyarticular onset JRAc. Systemic - onset JRA

2. Connective tissue disorder

a. SLEb. Dermatomyositisc. Scleroderma


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3. Vasculitides

a. Kawasaki disease involving smaIl jointsb. Henoch schonlein purpurac. Polyarteritis nodosa

4. Spondyloarthropathy

a.

Juvenile spondyloathropathyb. Ankylosing spondylitisc. Reiter's syndromed. Psoriatic arthritise. Inflammatory bowel disease

5. Others:

a. Marfan syndromeb. Ehlers danlos syndromec. Cystic fibrosisd. Hemolytic anaemiae. Sarcoidosisf.

Villonodular synovitisg. Mucopolysaccharidoses

h. Familial hypertrophic synovitis More commanly monoarticular / oligoarticularDifferentiating features between organic and functional joint pains:

Juvenile rheumatoid arthritis:

JRA usually starts between 1 and 4 years of age and near by 9 and 14 years of age.

Classification:

Depending upon the number of joints involved during the first 6 months after disease

onset (not the number of joints involved when the child is first seen by doctor) JRA isclassified into following subtypes:

Organic J oint Pains Functional J oint PainSymptoms:

- Occurs day and night - Occurs at night or in morning

before school

- Not related to school days - Occurs during school days.- Interference with daily activity - Interference with day to day

activity not there- Located in joints - May be located between

joints at bones

Signs:

- Limp ++ -- Evidence of inflammation +ve -ve

- ROM restriction ++ -

- Muscle weakness +- -

- S stemic menifestation + -


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A. Polyarticular: Multiple joints, small or large are involved in a symmetrical fashion,more common in female. It can be subclassified into following types

a. RA-positive polyarticular: Usually late childhood onset, RA nodule is common. Itis associated with poorer prognosis.

b. RA-negative polyarthritis: Better prognosis, may present in early or latechildhood.B. Pauciarticular: One or few ( 6 years): More often in males, more often HLA B-27 positive,ANA negative, some may have spondyloarthropathy like adults.

c. Systematic onset: It is characterized by polyarthalgia, polyarthritis with systemicmanifestations such as high fevers, evenescent rash etc. The gender frequency as

well as age of onset is equally distributed throughout childhood. Usually RA andANA negative.

Differentiating features of three types of JRA:

Extraarticular manifestations of systemic onset JRA:1. Intermittent fever: A persistent intermittent fever with diurnal variation between

102 f and 106 f with returns to normal is a must for diagnosis.2. Skin rash: Evanescent, pink, macular pale centre, on chest and limbs may be seen

in associated with fever.3. Hepatomegaly / mild liver dysfunction4. Pericarditis5. Splenomegaly6. Leucocytosis7. Lymphadenopathy8. Severe anaemia9. DIC syndome

Polyarthritis Oligoarthritis Stills disease

Incidence 40% 50% 10%

No of joints involved 5 4 variable

Sex ratio F>M F


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Diagnostic criteria for JRA

1. Age of onset below 16 years2. Polyarthritis or monoarticular arthritis lasting longer than 3 month3. Swelling or presence of atleast 2 of following:

a.

Heatb. Painc. Tendernessd. Restriction of motion

4. Type of onset, classified as:a. Polyarthritisb. Oligoarthritisc. Systemic illness: including arthritis, intermittent fever, rheumatoid rash.

5. Exclusion of other forms of arthritis

Differentiating features between systemic JRA and SLE:

Treatment:

Medical management:A.Nonsteroidal antiinflammatory drugs

1. Salicylate: (80 -130 mg/kg 1 day)2. Indomethacin: (0.5 -3 mg/kg 1 day)

B. Slowly acting antirheumatic drugs:1. 1M gold: 1 mg/kg weekly interval2. Auranofin: 0.15 -0.20 mg/kg 1 day3. Hydroxychroquine: 5 -7 mg/kg 1 day4. Sulfasalazine: 40 mg/kg/day5. Methotrexate: 0.15 -0.5 mg/kg/wk.6. Etarnacept: 0.4 mg/kg

C. Steroids

1. Prednisolone: 1 -2 mg/kg/dayD. Conservative orthopaedic management:

1. Rest2. Exercise: gradual excercise within pain tolerance limits3. Heat therapy

Features Systemic JRA SLEAge 1 -15 years of age 5 yearsLE cells - +

Oral lesions - +

Evanescent rash + -Leukocytosis + -

Renal abnormalities - +

ANA +

Absence of ANA rules out SLE


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4. Orthosis or plaster cast5. Traction if needed

E Family supportF Regular eye-check ups and treatment

G Surgery: Surgical options include

1.

Synovectomy2. Joints replacement / arthrodesis in severly affected joints3. Corrective osteotomies in joint deformities4. Soft tissue release in joint deformities