Juvenile idiopathic arthritis (JIA)!

Juvenile idiopathic arthritis (JIA) 🚀

🎷 the most common rheumatic disease in children

💎Criteria for the Classification💎

📿Age at onset: <16 yr


swelling or effusion, or the presence of ≥2 of :

🎓limitation of range of motion

🎓 tenderness or pain on motion,

🎓increased heat) in ≥1 joint

📿Duration of disease: ≥6 wk

📿Onset type defined by type of articular involvement in the 1st 6 mo after onset

🎭Polyarthritis: ≥5 inflamed joints

🎭Oligoarthritis: ≤4 inflamed joints

🎭Systemic-onset disease: arthritis with rash and a characteristic quotidian fever


🎷≤4 joints within the 1st 6 mo of disease


🎷 affects the large joints of the lower extremities, such as the knees

and ankles

🎓Those in whom disease never develops in >4 joints ➡️ persistent oligoarticular JIA ,

🎓evolution of disease in >4 joints

after 6 mo changes the classification to extended oligoarticular JIA

😢associated with a worse prognosis.

🔔Isolated involvement of the hip is almost

never a presenting sign and suggests ERA or a nonrheumatic



🏓inflammation of ≥5 joints in both upper and

lower extremities

🏓Rheumatoid nodules on the extensor surfaces of the

elbows, spine, and over the tendon Achilles = a more severe course

🏓almost exclusively occur in RF-positive


🤪 Micrognathia reflects chronic temporomandibular

joint disease

😢Cervical spine involvement


🏓as decreased neck extension

🏓atlantoaxial subluxation and

neurologic sequelae.

🙃Hip disease may be subtle, with findings of decreased or painful ROM on examination

🍡Systemic JIA is characterized 🍡


🚀 as spiking temperatures to ≥39°C

🚀daily or twice-daily basis for at least 2 wk,

🚀 rapid return to normal or subnormal temperatures

🚀in the evening


🎉 faint,

🎉erythematous, macular rash.

🎉salmon-colored lesions

🎉usually distributed over the trunk and

proximal extremities

🎉nonpruritic and migratory with lesions lasting <1 hr.

🎭Koebner phenomenon :

a cutaneous hypersensitivity Caused by superficial trauma.

🎭hepatosplenomegaly, and

lymphadenopathy are present in >70% of affected children.


classically polyarticular, may be very destructive, and

can include hip, cervical spine, and temporomandibular joint involvement.


🏆JIA is a clinical diagnosis without any diagnostic laboratory tests

🔔 clinical exclusion of other diseases and many mimics is therefore


🎑ANA and RF, are only supportive or prognostic, and their results may be normal in patients with JIA

🔔 ANA seropositivity is associated with

increased risk of chronic uveitis in JIA

🎑RF, is a marker of more aggressive disease.

🏜️Characteristic radiographic changes in cervical spine, most frequently in the

neural arch joints at C2-C3 , may progress to atlantoaxial


🏜️MRI is more sensitive than radiography to detect early changes.

🏜️Differential Diagnosis🏜️

🍡Systemic lupus erythematosus

🍡Juvenile dermatomyositis

🍡Henoch-Schönlein purpura

🍡Psoriatic arthritis

🍡Reactive arthritis

🍡Infectious Illnesses

🍡Bacterial arthritis

🍡Acute rheumatic fever



🍡Thyroid disease (hypothyroidism, hyperthyroidism)

🍡Vitamin C deficiency (scurvy)

🍡Hereditary connective tissue disease (Marfan syndrome


🍡Neuropathic Disorders

🔔Neoplastic Disorders




🍡Bone tumors (osteosarcoma, Ewing sarcoma)

🔔Hematologic Disorders


Hemoglobinopathies (including sickle cell disease)


🗽The goals of treatment are :

🎉disease remission,

🎉prevent or halt joint damage

🎉foster normal growth and development.

😁All children with JIA need

individualized treatment plans, and management is tailored according to disease

subtype and severity, presence of poor prognostic indicators, and response to


🎑antiinflammatory drugs (NSAIDs), with improvement in inflammation and pain

🔔 Those who have no or partial response after 4-6 wk of treatment

with NSAIDs, or who have functional limitations such as joint contracture or

leg-length discrepancy, benefit from injection of intraarticular corticosteroids.

🎑diseasemodifying antirheumatic drugs (DMARDs), including methotrexate, and, if no

response, TNF inhibitors.