juvenile%20idiopathic%20arthritis
JUVENILE IDIOPATHIC ARTHRITIS
Juvenile idiopathic arthritis was formerly known as juvenile rheumatoid arthritis or juvenile chronic arthritis.
It presents as chronic joint swelling, pain with functional limitation for at least 6 weeks of unknown cause that starts before 16 year of age.
It is the most common autoimmune-autoinflammatory disease in children.
Around half of the children with juvenile idiopathic arthritis may have active disease until adulthood.

Follow Up

  • Patients are considered to have inactive disease if they have no active synovitis, fever, rash, serositis, splenomegaly, generalized lymphadenopathy, or active uveitis, have normal erythrocyte sedimentation rate (ESR) &/or C-reactive protein (CRP), & the physician’s global assessment indicates no active disease
    • Patient on medication who have inactive disease for 6 consecutive months is considered to have as clinical remission on medication
    • Patients not taking any anti-arthritis or anti-uveitis medication & have inactive disease for 12 continuous months are considered to have clinical remission
  • Ten year remission rate in 50% of patients w/ oligoarthritis is noted; 40% in patients w/ systemic arthritis & 15% in patients w/ polyarthritis
    • Long-term remission in patients w/ rheumatoid factor (RF)-positive polyarthritis is unlikely
  • Follow up of patients depend on the disease severity & medications given; may be every 2 weesk-3 months
  • Activity of arthritis should be evaluated at least 3x/year & treatment be adjusted to reduce joint swelling & tenderness
  • Should identify complications of JIA such as macrophage activation syndrome (MAS)
    • An uncommon but potentially fatal complication of systemic-onset JIA
    • Patients are diagnosed through presence of ≥2 lab criteria (eg ≤262 x109/L platelet count, >59 U/L aspartate aminotransferase (AST), ≤4 x109/L white blood cell (WBC), or ≤2.5 g/L fibrin), or any ≥2 clinical (eg CNS dysfunction, hemorrhages, or hepatomegaly) &/or lab criteria
    • Patient may also present w/ acute onset of severe anemia coupled w/ thrombocytopenia or leukopenia that have high spiking fevers, lymphadenopathy, & splenomegaly
    • May be differentiated from patients w/ exacerbation of systemic disease through fall of ESR secondary to hypofibrinoginemia & hepatic dysfunction
    • Diagnosis is confirmed by hemophagocytosis seen in bone marrow biopsy
    • High-dose intravenous (IV) Methylprednisone, Cyclosporine, or Anakinra may be effective emergency treatment
  • Screening of comorbidities should also be done
  • TB testing should be repeated at least once every year in all patients maintained on anti-TNF-α agents
  • Patients who are female, <6 years old at JIA onset, w/ oligoarthritis subtype, w/ <4 years duration, w/ positive ANA & negative RF are considered at high risk to develop uveitis & should be screened every 3-4 months
    • Patients w/ medium risk (ie oligoarthritis or polyarthritis, ≥6 year old at onset, w/ negative ANA) should be screened every 6 months, & yearly for those at low risk (eg systemic-onset JIA)
  • Safety of treatment given should be regularly assessed
    • Monitoring for nonsteroidal anti-inflammatory drug (NSAID) use
      • Serum creatinine (Cr), complete blood count (CBC) & liver function test (LFT) should be measured prior to or soon after the initiation of treatment
      • Serum Cr, urinalysis, CBC & LFT should be checked 2x/year in patients maintained on long-term daily NSAIDs & yearly for patients taking NSAIDs routinely
    • Monitoring for Methotrexate use
      • Serum Cr, CBC & LFT should be measured prior to, 1 month after the initiation of treatment & 1-2 months after a dose escalation
      • 3-4 monthly measurement of serum Cr, CBC & LFT should be recommended in patients receiving stable dose of Methotrexate w/ no recent history of abnormal lab results
      • Lab tests should be done 1-2 days before the scheduled weekly dose of Methotrexate
      • For abnormal LFT results, the following are recommended:
        • LFT 2x upper limit of normal (ULN): no specific action or recheck LFT at shorter interval
        • LFT >2x ULN: reduce dose or temporarily stop the medication
        • LFT >3x ULN even after decreasing the dose: discontinue use
    • Monitoring for anti-TNF-α use
      • If drug will be used continuously, serum Cr, CBC & LFT should be tested prior to therapy & every 3-6 months thereafter
  • For patients who fail to have disease control w/ any of the medications, autologous stem cell transplantation may be an option to achieve disease remission, but is still currently being evaluated
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
08 Dec 2017
Adults born very preterm, whether with or without bronchopulmonary dysplasia (BPD), appear to have anatomically smaller airways compared with their counterparts who were born full-term, a recent study suggests.
Audrey Abella, 31 Jan 2017
Nonsteroidal anti-inflammatory drug (NSAID) treatment for patent ductus arteriosus (PDA) in preterm infants did not reduce the odds of mortality or bronchopulmonary dysplasia (BPD), a recent US study found.
Jairia Dela Cruz, 13 Oct 2016
Children born to obese mothers are at increased risk of developing autism spectrum disorder (ASD) compared with children born to normal-weight mothers, according to data from a review and meta-analysis.
07 Dec 2017
Lactobacilli bacteria appear to be less abundant in the guts of male infants born to asthmatic mothers, a recent study shows. On the other hand, Bacteroidaceae are more abundant in the guts of female infants.