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juvenile idiopathic arthritis

Classification: - oligoarticular: synovitis of <= 4 joints, may present in adulthood [2] - systemic: daily high fevers & transient rashes during childhood - TMJ syndrome, micrognathia & complication of uveitis not features [2] Etiology: - antibiotics may be a risk factor (RR=2) [1] Epidemiology: - female > male - peak incidence 2-4 years of age Clinical manifestations: - clinical phenotypes - active systemic features with varying degrees of synovitis - no active systemic features with varying degrees of active synovitis - features concerning for macrophage activation syndrome - onset in childhood - synovitis of up to 4 large joints, generally knees & ankles but may involve wrists & elbows (oligoarticular) - temporomandibular joint arthritis (pain & crepitus) - micrognathia (may be due to TMJ syndrome) - leg length discrepancy Special laboratory: - modestly elevated antinuclear antibody - testing for latent tuberculosis in patients taking biologics Complications: - autoimmune uveitis Management: - treat TMJ syndrome - non-steroidal anti-inflammatory drugs - glucocorticoids: systemic, intra-articular - disease-modifying antirheumatic drugs (DMARDs) - TNF-alpha inhibitor - adalimumab, etanercept - abatacept - methotrexate - leflunomide - tocilizumab - other biologic agents - anakinra - canakinumab - sarilumab (Kevzara) - calcineurin inhibitor

Related

juvenile rheumatoid arthritis; juvenile idiopathic arthritis; Still's disease

Specific

enthesitis-related arthritis

General

arthritis developmental bone disorder

References

  1. Horton DB, Scott FI, Haynes K et al Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case-Control Study. Pediatrics. July 20, 2015 PMID: 26195533 http://pediatrics.aappublications.org/content/early/2015/07/15/peds.2015-0036
  2. NEJM Question of the Week, Dec 25, 2018 https://knowledgeplus.nejm.org/question-of-week/1885/
  3. Weiss PF et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arthritis Rheum 2008 Apr; 58:1189. PMID: 18383394 Free full text
  4. Billiau AD et al. Temporomandibular joint arthritis in juvenile idiopathic arthritis: prevalence, clinical and radiological signs, and relation to dentofacial morphology. J Rheumatol 2007 Sep; 34:1925. > View Abstract PMID: 17696265
  5. Macaubas C et al. Oligoarticular and polyarticular JIA: epidemiology and pathogenesis. Nat Rev Rheumatol 2009 Nov; 5:616. PMID: 19806151 Free PMC Article