Juvenile Rheumatoid Arthritis

JRA : one of the most common rheumatic disease of children, and major cause of chronic disability.

Characterized by an idiopathic synovitis of the peripheral joints, associated with soft tissue swelling and effusion.

Etiology : ? (still unknown)

Epidemiology :

Incidence : 13,9/100.000 people

Age <15 years of age

Prevalence : 113/100.000 children

Clinical manifestations :

Morning stiffness & gelling

Ease of fatigue particularly after school in the early afternoon

Joint pain & swelling

The involved joint is often warm, lacks of full range of movement

Painful of movement (without erythematous)

Oligoarthritis (pauciarticular arthritis) predominantly affects the joints of lower extremities

Polyarthritis (polyarticular disease) is characterized by involvement of both large & small joints.

Inflammation of only 5 or more joint.

Systemic-onset disease characterized by a quotidian fever with daily temperatur spikes to at least 39oC (minimum of 2 weeks)

Each febrile episode, often accompanied by a a characteristic faint erythematous macular rash.

Patients with systemic-onset disease often have prominent visceral involvement (including : hepatosplenomegaly, lympadenopathy, serositis; such as a pericardial effusion)

Radiography

On the affected joints:

Soft tissue swelling

Osteoporosis

periostitis

Treatment

Combination therapy with least toxic medications, usually nonsteroidal anti-inflammatory agents and proceeding through hydroxychloroquine, methotrexate, or possibly immunosuppressive or experimental drugs

Corticosteroids ® for systemic illness, in lower doses for ”bridge therapy” for the child who has not yet responded to the addition of a drug such as methotrexate, and for ophthalmic & intra-articular use.

Methotrexate is considered the safest, most efficacious, and least toxic of the currently available second-line agents.

NSAID(non steroidal anti-inflammatory drugs)

To decrease inflammation May appear: nausea, decreased appetite, abdominal pain

50-60% JRA patients had significant improvement with NSAID.

Corticosteroids

May given by various routes : ocular,oral, IV, intraarticular

Eye drops or subtenon injections: For uveitis associated with JRA

Long term oral corticosteroids always lead to side effects.

IV corticosteroids was used to treat the more severe, acute systemic connective tissue disease

Intraarticular corticosteroids: for JRA which not responded to standard therapy or as the initial treatment for pauciarticular JRA.

Goal : to maximize the daily functional activities of anaffected child, release discomfort,prevent or reduce organ damage, and avoid/minimize drug toxicity.

As a physician :

Treating the rheumatic disease

Prescribing & monitoring medications

Coordinating with other medical team

Educating the patient and whole family member about the disease

Non pharmacotheraphy treatment

Rehabilitation & Physiotherapy

–To prevent the involved joint become contracture

Stretching

Hydrotheraphy

Regular swimming

Surgery

–To correct the joint deformity or even the deformity that had already occured

Nutrition

Education

–About the treatments, nature, expected course of the disease to the patients & all the family member

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