241: JUVENILE RHEUMATOID ARTHRITIS

CONDITION/DISORDER SYNONYMS

• Juvenile idiopathic arthritis (JIA)

• Juvenile rheumatoid arthritis (JRA)

ICD-9-CM CODES

• 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

ICD-10-CM CODES

• M08.00 Unspecified juvenile rheumatoid arthritis of unspecified site

• M08.3 Juvenile rheumatoid polyarthritis (seronegative)

• M08.40 Pauciarticular juvenile rheumatoid arthritis, unspecified site

PREFERRED PRACTICE PATTERN

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

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• 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)

General Considerations

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

Demographics

• 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

CLINICAL FINDINGS