Pediatrics · MU Sofia

24. JRA, reactive arthritis and spondyloartritis.

Covers juvenile idiopathic arthritis with its ILAR subtypes set out in a table, including who each subtype affects and its features, plus macrophage activation syndrome and the eye screening and treatment options. It then describes reactive arthritis after infection, distinguishing it from acute rheumatic fever and septic arthritis using Kocher criteria, and transient hip synovitis. The note closes with juvenile spondyloarthritis, other joint pain causes not to miss, and temporomandibular joint involvement in JIA.

Inside: 5 sections · 1 table · 16 flashcards · 5 min

Topic 24 of 30 in the MU Sofia syllabus for Pediatrics (Medicine, Year 5). The free AceMed note covers it in 5 sections, about 526 words (5 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Juvenile idiopathic arthritis
  3. Reactive arthritis
  4. Juvenile spondyloarthritis
  5. Other causes of joint pain not to miss

Introduction

A child with a swollen, painful or stiff joint has a wide list of causes, from harmless to urgent. Juvenile idiopathic arthritis (JIA) is the commonest chronic rheumatic disease of childhood; reactive arthritis follows an infection; spondyloarthritis affects entheses and the spine and is linked to HLA-B27.

Juvenile idiopathic arthritis

Arthritis starting before 16 years, lasting at least 6 weeks, with other causes excluded. About 1 in 1000 children. Morning stiffness, swelling, limping, reduced range, less playing; pain is often mild.

Macrophage activation syndrome complicates systemic JIA: persistent fever, falling ESR and platelets, very high ferritin, high triglycerides, low fibrinogen, liver dysfunction, bleeding. It is life-threatening: high-dose steroids, ciclosporin, anakinra.

Tests

JIA is a clinical diagnosis; tests exclude others and classify: blood count and film (exclude leukaemia), CRP/ESR, ANA, rheumatoid factor, anti-CCP, HLA-B27; ultrasound or MRI of joints; joint aspiration if infection is possible. Eye screening by slit lamp every 3–6 months in oligo- and polyarticular JIA (uveitis has no symptoms and can blind).

Treatment

  • NSAIDs (naproxen, ibuprofen) for symptoms.
  • Intra-articular steroid (triamcinolone hexacetonide): first choice for oligoarthritis.
  • Methotrexate weekly (with folic acid) for polyarthritis and resistant disease.
  • Biologics: anti-TNF (etanercept, adalimumab, the latter also for uveitis), abatacept, tocilizumab; IL-1 or IL-6 blockade (anakinra, canakinumab, tocilizumab) for systemic JIA; JAK inhibitors.
  • Physiotherapy, splints, exercise, school support, psychological help.

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