Child Abuse, Polyarticular JIA 4/5 (1)

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Polyarticular Juvenile Arthritis (ICD-10: M08.3, seronegative type, M08.0, seronegative or seropositive)

Polyarticular JIA

Polyarticular childhood arthritis attacks five or more joints

Definition

Polyarticular Childhood Arthritis (Polyarticular JIA) includes all children with joint inflammation at least 5 different swollen joints (polyarticular arthritis) during the first 6 months of the disease. This form of childhood arthritis can be divided into them without detectable rheumatoid factors (RF, CCP) (“seronegative”) and those with  rheumatoid factors ("seropositive").

  1. Joint inflammation (polyarthritis) without rheumatoid factors (seronegative)
    This type includes 30% of childhood arthritis cases and has girl: boy occurrence on 3: 1
    • The disease usually debuts in 6-12's age
    • All children have at least 5 inflammed joints within the 6 first months from disease start
    • Uveitis (inflammation of the eye)  can cause permanent damage with reduced vision) occurs in 10%, and the blood test ANA which increases the risk of eye damage is detected in 40%
    • Signs of inflammation can be seen in blood tests such as c-reactive protein (CRP) and blood loss reaction (SR), but they are often only slightly elevated
  2. Joint inflammation (polyarthritis) with rheumatoid factors
  • Occurs at less than 10% among those with childhood arthritis
    • Girl: boy's distribution is 9: 1
    • The disease may look similar to Rheumatoid arthritis in adults
    • Blood tests often show a slightly elevated blood drop reaction (SR) and CRP, as well as the incidence of rheumatoid factors (RF, CCP)
Polyarticular childhood arthritis

Polyarticular JIA, Dep Ped, Chungbuk National University College of Medicine, Cheongju, Korea. CC BY NC 3.0

Treatment

The aim of the treatment is to achieve absence of fever, joint inflammation, permanent joint injury, damage to the eyes and internal organs. The treatment should at the same time alleviate pain and contribute to as normal upbringing as possible.

  • Non-medical treatment including physiotherapy is combined with drugs
  • NSAIDs (ibuprofen, naproxen) have some effect, but must usually be combined with disease-modifying other medications
  • Methotrexate (tablets or injections) are useful for most people with polyarticular juvenile arthritis.
    • Methotrexate reduces disease activity and thus pain, stiffness and development of joint damage.
    • The effect occurs during 2-3 months and lasts as long as one uses the drug.
  • Although cortisone preparations are avoided as far as possible, often need to be done Prednisolone (tablets) used over a period of time.
  • If necessary, one can Biological medicine added, of which TNF inhibitors are the first choice.
    • The longest experience has one with etanercept (Benepali, Enbrel) and adalimumab (Humira).

Literature

Children with rheumatic disease, BINDEVEVSSYKDOMMER.no


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