RHEUMATIC DISEASE in

CHILDREN
Editha C> Dizozn, MD
School of Physical Therapy
FEU-NRMF
JUVENILE Idiopathic Arthritis (JIA)
Juvenile Rheumatic Arthritis
Chronic Childhood Arthritis
Most common
Chronic Childhood Arthritis
Systemic Arthritis
Oligoarthritis
RF-negative Arthritis
RF-positive Arthritis
Psoriatic Arhtritis
Enthesitis-related Arthritis
Undifferentiatied Arthritis
Before age 16

At least 6 weeks

No other known conditions

Etiology unknown

Possible genetic and environment

Early arthritis
Swelling

Warmth

Joint stiffness

Fluctuates

Worse in the beginning of the day  improves with activity

Rarely : joint pain

Chronic arthritis
Local growth disturbance
Overgrowth
Undergrowth
Aberrant
Micrognathia
Leg length discrepancies
Develpmental hip anomalies

Note : steroids – affect growth

- osteoporosis
Poor Outcome
Greater severity or extension of arthritis
at onset
Symmetrical disease
Early wrist or hip involvment
Presenc of RF
Persistent active disease
Early radiographic changes
Antinuclear antibodies
Antinuclear antibodies
Macrophage Activation Syndrome
MAS
Life-threatening

Fever, lymphadenopathy, splenomegaly

Depressed blood cells (platelets)

Increased liver funciton enzymes

Clotting abnormalities
Still’s
50% relapsing-remitting – good

50% unremitting – severe joint destruction

1/3 - severe arthritis

Poor prognosis
 Continued presence of systemic features
 > 600,000 platelet six months after onset
Oligoarthritis
Types
 Persistent - < 4 joints
 Extended - > 4 joints

 early onset before 6 years

 asymmetric usually LE

 predominant females

 ANA in 70-80%

Generally best outcome but sight threatening

Iridocyclitis
Psoriatic Arthritis
 5%

 Arthritis + psoriasis

 Before age 5 – more difficult

to control
Psoriatic Arthritis
 (-) rash

 Arhtritis + 2 of the ff:

 Family history of psoriasis in
a first degree relative
 Dactylitis
 Nail pitting
Enthesitis-related Arthritis
Males after 6 years

Most with HLA-B27

Arthritis – LE esp hip

Most common sites

 Calcaneal insertion of achilles tendon
 Plantar fascia
 Tarsal area
Enthesitis-related Arthritis
Uveitis – sudden, symptomatic and unilateral

May progress:
 Ankylosing Spondylitis
 Reactive Arthritis
 IBD