JUVENILLE IDIOPATHIC ARTHRITIS (JUVENILLE RHEUMATOID ARTHRITIS)

>Juvenile idiopathic arthritis (JIA) new name for chronic childhood arthritis (JRA) >JIA is a group of idiopathic chronic inflammatory diseases affecting the joints and other tissues >1/1000 children >female predominance of 21 >Two peak ages of onset between 1 and 3 y/o and 8 and 10 y/o. MANIFESTATION: >stiffness, swelling and loss of motion develop in the affected joints. >swollen and warm to touch but seldom red. >swelling result from edema, joint effusion, and synovial thickening >affected joint may be tender and painful to touch or relatively painless. >limited motion early in the disease is a result of muscle spasm and joint inflammation. >morning stiffness, or gelling of joints >In a severe long-standing cases growth is significantly retarded. >there may be growth disturbance, either overgrowth or undergrowth, adjacent to the inflamed joints and microganthia (receding chin) from temporomandubular arthritis. DIAGNOSIS: >JRA and JIA are diagnoses of exclusion, there are no definitive tests. >an elevated sedimentation rate (ESR) may or may not be present. >test for Rheumatoid Factor (RF) give positive results in only 10% of children with JIA/JRA > (+) antinuclear antibodies (ANA) are common, but not specific for arthritis. TREATMENT: >there is no cure >major goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation >promote normal growth and development >outpatient care is the mainstay of therapy

>regular Slit-lamp ophthalmologic examination, to diagnose chronic anterior uveitis (iridocyclitis) inflammation of the anterior segment of the eye, iris and ciliary body MEDICATIONS: NSAIDs first drug used >ibuprofen, naproxen, tolmetin, diclofenae, indomethacin and nabumetone *NASAID for at least 3 weeks before effectiveness can be elevated. slower-acting antirheumatic drugs (SAARDs) >methotrexate, sulfasalazine, and hydroxychloroavine *weekly low-dose of methotrexate therapy is the first SAARD regimen used Corticosteroids most potent anti-inflammatory disease; however, they will not cure arthritis >high dose IV steroids (for severe arthritis) Biologic agents: Etanercept >sued after unsuccessful treatment with NSAIDs and methotrexate Cytotoxic Agents >cylcophosphamide, azathioprine, cycoporine and chlorambutil Physical Management: >to reach the ultimate goal of pressuring function and preventing deformity. >physical therapy (exercising in pool, splinting and positioning during rest, no pillow or very low one) Surgery: >Synovectomy is used primarily in pauciaarticular disease Nursing Mangament: >Relieve pain >promote general health (diet and exercise, sleep and rest) >encourage school attendance >facilitate compliance >Encourage comfort measures and activities of daily living