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CONDITION/DISORDER SYNONYMS

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  • Juvenile idiopathic arthritis (JIA)

  • Juvenile rheumatoid arthritis (JRA)

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ICD-9-CM CODES

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  • 714.3 Juvenile chronic polyarthritis

  • 714.30 Chronic or unspecified polyarticular juvenile rheumatoid arthritis

  • 714.31 Acute polyarticular juvenile rheumatoid arthritis

  • 714.32 Pauciarticular juvenile rheumatoid arthritis

  • 714.33 Monoarticular juvenile rheumatoid arthritis

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ICD-10-CM CODES

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  • M08.00 Unspecified juvenile rheumatoid arthritis of unspecified site

  • M08.3 Juvenile rheumatoid polyarthritis (seronegative)

  • M08.40 Pauciarticular juvenile rheumatoid arthritis, unspecified site

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PREFERRED PRACTICE PATTERN

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  • 4D Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

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PATIENT PRESENTATION

A 3-year-old is hospitalized due to severe knee pain, unwillingness to weight bear, and daily fevers. Following a medical examination including X-rays and blood work, the child is diagnosed with JRA. Upon examination, the therapist notes erythema, edema, and tenderness to palpation of both knees. The child has decreased active knee flexion and extension but is now able to stand with support.

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KEY FEATURES

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Description
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  • Overarching name for multiple disorders

  • Chronic inflammation of one or more joints for more than 6 to 12 weeks

  • Characterized by acute and chronic episodes, may involve other areas of the body

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Essentials of Diagnosis
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  • International League of Associations for Rheumatology classification

    • Oligoarticular (50% of cases) defined as four or fewer joints involved2

      • Persistent

      • Extended

      • Asymmetrical

      • Polyarticular (35% of cases) defined as five or more joints involved, often symmetrical2

      • Rheumatoid factor-positive (more destructive, similar to adult form)

      • Rheumatoid factor-negative

    • Systemic, also known as Still’s disease, (10%–15% of cases) high fever once or twice a day (often in afternoon) with macular rash on bony prominences during fever spikes; can have hepatosplenomegaly, leukocytosis, lymphadenopathy2

    • Enthesitis (<10% of cases) affects mainly legs at tendon insertions in boys greater than 10 years of age 2

    • Psoriatic arthritis (10% of cases)

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General Considerations
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  • Characterized by periods of acute inflammation followed by chronic residual damage

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Demographics
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  • Onset before 16 years of age

  • Oligoarticular and enthesitis in males greater than 8 years of age

  • Polyarticular rheumatoid factor-negative

    • 50% of cases occur in children younger than 6 years old

    • Onset often during adolescence

    • More common in females than males

  • Polyarticular rheumatoid factor-positive

    • Primarily in females

    • Onset in adolescence or late childhood

  • Systemic

    • Onset anytime in childhood

  • Psoriatic

    • Onset usually in 2- to 4-year-olds and 9- to 11-year-olds

    • More common in females than males

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • In one or more joints (unilaterally or bilaterally)

    • Pain

    • Swelling

    • Redness

    • Increased warmth to palpation

  • Tenderness

  • Morning stiffness

  • Rash3

  • Fever

  • Uveitis (inflammation of eye) often asymptomatic

  • Serositis (inflammation in the lining of the heart, lungs, abdomen)

  • Fatigue

  • Anemia

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FIGURE 241-1

Childhood Health Assessment Questionnaire. (Data from JRA Outcome Study Form: Haq Childhood Health Assessment Questionnaire (CHAQ). Copyright © American College ...

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