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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 Diagnosis2

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  • International League of Associations for Rheumatology classification
    • Oligoarticular (50% of cases) defined as 4 or fewer joints involved2
      • Persistent
      • Extended
      • Asymmetrical
    • Polyarticular (35% of cases) defined as 5 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 to 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 over 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 over 8 years of age
  • Polyarticular rheumatoid factor-negative: 50% of cases occur in children younger than 6 years old; otherwise, 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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Signs and Symptoms

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  • In one or more joints (unilaterally or bilaterally)
    • Pain
    • Swelling
    • Redness
    • Increased warmth to palpation
  • Tenderness
  • Morning stiffness
  • Rash
  • Fever
  • Uveitis (inflammation of eye) often asymptomatic
  • Serositis (inflammation in lining heart, lungs, abdomen)
  • Fatigue
  • Anemia

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Functional Implications

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  • Difficulty with activities of daily living (ADLs)
  • Difficulty with transfers, such as rising from furniture
  • Difficulty climbing stairs
  • Decreased endurance

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Possible Contributing Causes

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  • Unknown etiology
  • Autoimmune disease theorized
  • Genetic link with viral or bacterial trigger

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Differential Diagnosis

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  • Must rule out
    • Orthopedic conditions (increased pain with activity)
    • Infection of joint or infectious disease
    • Cancer

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Laboratory Tests

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Imaging

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