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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Evaluate signs and symptoms including joint soreness, stiffness, and inflammation related to juvenile idiopathic arthritis.
Design interventions to protect the joints and maximize function.
Evaluate activities of daily living to determine if adaptive equipment is indicated.
Analyze the biomechanics of movement to assist in developing a comprehensive physical therapy plan of care.
Educate families on juvenile idiopathic arthritis and provide resources on how medical intervention can improve long-term prognosis.
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Juvenile arthritis is the most common childhood disease with a prevalence of 1 per 1000 children.1-3 Juvenile idiopathic arthritis (JIA) (formerly known as juvenile rheumatoid arthritis or pediatric rheumatoid arthritis) refers to a group of autoimmune and inflammatory disorders acquired in children before the age of 16 years with chronic inflammation of one or more joints for more than 6 weeks.4 The common signs and symptoms include fatigue, rash, morning stiffness, joint redness, swelling, pain, and tenderness unilaterally or bilaterally.5-13 JIA is characterized by acute and chronic episodes and can affect one or multiple areas of the body. If not detected in the early stages, permanent damage can occur. There is no known etiology10 and no known cure.11 Primary treatment includes different medications to reduce inflammation, pain, and prevent joint degradation. The condition can go into remission. Secondary treatment is directed at joint protection and maximizing function.
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JIA is an exclusion diagnosis is made through a combination of methods. Taking a thorough subjective history is very important and can assist the physician in the differential diagnosis. A traditional physical exam that examines joint range of motion is important. Blood work is commonly ordered to investigate markers such as antinuclear antibodies (ANA), rheumatoid factor (RF), and many others. Imaging is often ordered to confirm the diagnosis and identify if any joint damage has occurred. Plain radiography can be used to look at joint space and congruence when evaluating the presence of degradation of the joint in relation to JIA (Figure 15-1).14 Magnetic resonance imaging can detect synovial hypertrophy and articular cartilage abnormalities.14 Biochemical changes can be detectable with magnetic resonance spectroscopy even before structural changes within the joint are detectable.14
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The 1995 International League of Associations for Rheumatology (ILAR) classification describes the 7 different types of JIA.4 The categories are defined by the number of joints involved, the presence or absence of extra-articular ...