Download Juvenile Rheumatoid Arthritis.

Juvenile Rheumatoid Arthritis.
Sakharova Inna. Ye., MD,
Univ. assistant
Juvenile Rheumatoid Arthritis (JRA)
is classified as a connective tissue
disease. It is a chronic systemic
inflammatory disorder that damages the
joints of the body.
Clinical features of JRA:
• Joint pain, stiffness, and swelling: These are the
most common symptoms of JRA, but many
children do not recognize, or do not report, pain.
Stiffness and swelling are likely to be more severe
in the morning.
• Loss of joint function: Pain, swelling, and stiffness
may impair joint function and reduce range of
motion. Some children are able to compensate in
other ways and display little, if any, disability.
Severe limitations in motion lead to weakness and
decreased physical function and sometimes to
invalidization.
• Limp: A limp may indicate a particularly severe
case of JRA, although it also may be due to other
problems that have nothing to do with arthritis,
such as an injury. In JRA, a limp often signals knee
involvement.
• Eye irritation, pain, and redness: These symptoms
are signs of eye inflammation. The eyes may be
sensitive to light. In many cases, however, eye
inflammation has no symptoms. If the
inflammation is very severe and not reversed, it
can cause loss of vision. The most common types of
eye inflammation in JRA are uveitis and iritis. The
names refer to the part of the eye that is inflamed.
• Recurrent fevers: Fever is high and
comes and goes with no apparent cause.
Fever may “spike” (go high) as often as
several times in one day.
• Rash: A light rash may come and go
without explanation.
• Myalgia (muscle aches): This is similar to that
achy feeling that comes with the flu. It usually
affects muscles throughout the whole body, not
just one part.
• Lymph node swelling. Swollen lymph nodes are
noticed most often in the neck and under the jaw,
above the clavicle, in the armpits, or in the
inguinal region.
• Weight loss. This is common in children with
JRA. It may be due to the child’s simply not
feeling like eating.
• Growth problems: Children with JRA
often grow more slowly than average.
Growth may be unusually fast or slow in
an affected joint, causing one arm or leg
to be longer than the other. General
growth abnormalities may be related to
having a chronic inflammatory condition
such as JRA or to the treatment,
especially glucocorticoids
Diagnostic criteria of JRA:
Clinical signs:
1. Arthritis more than 3 months (in Europe),
2.
3.
4.
5.
more than 6 weeks (in USA).
Next joint arthritis in 3 months and more
after the first joint affection
Symmetrical affection of small joints
Effusion in joint cavity (under the capsule)
Joint contracture.
Diagnostic criteria of JRA:
6. Tendosynovitis or bursitis.
7. Muscular atrophy.
8. Morning stiffness of joints.
X-ray signs:
1. Osteoporosis.
2. Articular cavities narrowing
3. Bone growth disturbances
The main JRA subsets:
Subset
# of Gend Age
joints
er
ANA RF Outcome
Pauciartic
ular
1-4
F
2 yrs
++
-
Good
50 %
Polyarticu
lar RF-
5
F
3-9
yrs
+
-
Poor
25 %
Polyarticu
lar RF+
5
F
Teens
+
+
Very
poor
Systemic
Any
Either 0-16
-
-
Very
poor
Laboratory tests in JRA
•
•
•
•
•
ANA (antinuclear antibody)
RF (Rheumatoid factor )
CRP (C-reactive protein)
ESR (erythrocyte sedimentation rate)
CCP (Cyclic Citrullinated Peptide Antibody)
test
Nonsteroidal anti-inflammatory
drugs (NSAIDs)
Medications
Aspirin
Doses
(mg/kg)
Side effects
50-120
Stomack pain, vomiting,
gastrointestinal
bleedings, headache,
blood in the urine, fluid
retention, thinning and
scarring of the skin
(especially with
naproxen), stomach
ulcer (aspirin).
Ibuprofen
10-30
Tolmentin
10-15
Naproxen
5-20
Slow-acting anti-rheumatic drugs
(SAARDs)
Medications
Hydroxychloroquine
(Plaquenil)
Sulfasalazine
(Azulfadine)
Doses
(mg/kg)
Side effects
5-7
Upset stomach, skin
rash and a eye
damage. A child who
takes this drug should
have his/her eyes
examined at least
every six months by
an ophthalmologist
Gold compaunds
Medications
Auranofin,
Ridaura,
Myochrysine
Solganol
Doses(weekly,
depending from
body weight )
20 kg – 10 mg
30 kg – 20 mg
40 kg – 30 mg
50 kg – 40 mg
> 50 kg – 50 mg
Side effects
Skin rash,
mouth sores,
kidney
problems, a low
blood count or
anemia
Slow-acting anti-rheumatic drugs
(SAARDs)
Medications
Week
of
treatm
ent
Doses
(mg/
kg)
Side effects
Penicillamine
(DePen,
Cuprimine)
0-2
2-4
4-6
6-8
10-14
25-50
50-100
100
100-150
150-200
Diarrhea, skin rash,
low blood counts,
nausea or vomiting,
stomach pain, loss
of appetite, swollen
glands, unusual
bleeding or bruising
Immune System Medications
(Cytostatics)
Medications
Doses
Methotrexate Typically 7.5 to
(Rbeumatrex) 25 mg a week
Azathioprine
(Imuran)
Cyclophospha
mide
(Cytoxan)
Side effects
Loss of appetite,
nausea or
vomiting, skin
rash, unusual
bleeding or
bruising,
tiredness or
weakness,
sterility.
Other medications
 Biologic Agents, which blocks the protein TNF
Etanercept (Enbrel)
Infliximab (Remicade)
 Glucocorticoid
Drugs
(Dexamethasone,
Methylprednisolone, Cortef, Prednisolone and
Prednisone)
 Analgesics (acetaminophen [Tylenol, Panadol],
tramadol [Ultram])
Very important parts of treatment for
juvenile arthritis:
• Therapeutic exercises
• Sports and Recreational Activities
• Splints
Very important parts of treatment for
juvenile arthritis:
•
•
•
•
•
Morning Stiffness Relief
Diet
Eye Care
Dental Care
Surgery