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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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- 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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- 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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- Patient may or may not have increased
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