Arthritis, juvenile rheumatoid

• Juvenile idiopathic arthritis (JIA)
• Juvenile rheumatoid arthritis (JRA)

• 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

• M08.00 Unspecified juvenile rheumatoid arthritis of unspecified site
• M08.3 Juvenile rheumatoid polyarthritis (seronegative)
• M08.40 Pauciarticular juvenile rheumatoid arthritis, unspecified site

• 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

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 Diagnosis2

(See also http://www.accessphysiotherapy.com/content/56826191.)

• 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)

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 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

Signs and Symptoms

• 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

Functional Implications

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

Possible Contributing Causes

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

Differential Diagnosis

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

Laboratory Tests

• Patient may or may not have increased
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein
  • White blood cell-count
  • Platelets
  ...