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Group 7

Group 7. Adrienne Grenier, Koteuaisa Wilson , Maura Comer, Alison Webb. Group 7. What Is Juvenile Rheumatoid Arthritis?. Arthritis is a disease in a person’s joints that cause swelling and pain where the bones meet each other, resulting in stiffness and loss of motion

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Group 7

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  1. Group 7 Adrienne Grenier, Koteuaisa Wilson , Maura Comer, Alison Webb

  2. Group 7

  3. What Is Juvenile Rheumatoid Arthritis? • Arthritis is a disease in a person’s joints that cause swelling and pain where the bones meet each other, resulting in stiffness and loss of motion • Juvenile Rheumatoid Arthritis is arthritis in children under 16 years old with inflammation lasting at least 6 weeks

  4. What Is Juvenile Rheumatoid Arthritis? • Juvenile rheumatoid arthritis is different from adult rheumatoid arthritis • Kids have different symptoms • The damage to bones is different

  5. How Is Juvenile Rheumatoid Arthritis Different From Adult Rheumatoid Arthritis? • Main Difference: Many people with JRA outgrow the illness, while adults usually have lifelong symptoms. • Studies estimate that by adulthood, JRA symptoms disappear in more than half of all affected children. • Unlike rheumatoid arthritis in an adult, JRA may affect bone development as well as the child's growth.

  6. Who Gets JRA? • About 1 child in every 1,000 develops some type of juvenile arthritis. • Approximately 75,000 children in the U.S. • Can affect children at any age, but uncommon in the first six months of life

  7. Why Do Kids Get JRA? • Cause is unknown • Research suggests a genetic predisposition • Triggered by an environmental factor, such as a virus • JRA is an autoimmune disease • Immune system mistakes healthy cells for harmful ones. • Body releases chemicals to fight healthy cells causing pain and swelling.

  8. Types of Juvenile Rheumatoid Arthritis • There are three types JRA. • Pauciarticular: fewer than five joints are affected. Usually knees and large joints. • Polyarticular: affects five or more joints. Joints on both sides of body are affected. Smaller joints like hands or toes. • Systemic JRA: affects many parts of the body. Heart, lungs and liver could be affected as well.

  9. Signs/symptoms • Limping • Stiffness when awakening • Reluctance to use an arm or leg • Reduced activity level • Persistent fever • Joint swelling

  10. Signs/symptoms

  11. Pathophysiology • Chronic inflammation of synovium is characterized by B lymphocyte infiltration and expansion. • Macrophages and T-cell invasion are associated with the release of cytokines, which evoke synoviocyte proliferation.

  12. Pathophysiology Continued… • 2001 study by Scola et al : • Found synovium to contain m-RNA for vascular endothelial growth factor, angiopoietin 1, and their respective receptors • This suggests that induction of angiogenesis by products of lymphocytic infiltration may be involved in persistence of disease. • The resulting thickened pannus causes joint destruction. In many patients, predominance of cytokines associated with tissue destruction, including interleukin-6 and TNF, suggests the possibility of improved responsiveness to specific biologic agents targeting these factors.

  13. Healthy Joint Vs. Damaged Joint

  14. One is normal, and one is a patient with JRA: Can you determine the differences? Active Learning:X-Ray of Patient

  15. How Is JRA Diagnosed? • Complete health history • Physical examination to look for joint inflammation, rashes, nodules, signs of internal organ inflammation and/or eye problems • Laboratory tests to help rule out other diseases • Erythrocyte sedimentation rate • Hemoglobin and blood count testing • Urinalysis • X-rays • Tests of joint, blood and tissue fluids to check for infections or inflammation

  16. Treatment Options • Goal: Control symptoms, prevent joint damage, and maintain function • 1. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) • Motrin or Advil • 2. Disease Modifying Drugs (DMARDS) • Hydroxychloroquine: Plaquenil • Sulfasalazine: Azulfidine • Methotrexate: Rheumatrex

  17. Medication Options • JRA is treated similarly to adult RA, although many drugs used to treat RA are not approved for children. • Aspirin, in large doses, is generally the first line of defense. • If the disease is progressive, anti-rheumatic drugs, such as methotrexate, injectable gold, can be used . • The new biologic agent, etanercept (Enbrel), was recently approved for treating JRA. Glucocorticoids, such as prednisone, are usually reserved for children with internal organ or eye inflammation because of the drugs' potential, at high doses, to stunt growth.

  18. Structure of Medications Plaquenil Rheumatrex Azulfidine

  19. Juvenile Rheumatoid Arthritis Medications Continued…

  20. Surgery • Rarely used in the early course of disease • Function: • Relieve pain • Release joint contractures • Replace a damaged joint

  21. Exercise • Target: • Shoulder • Neck • Lower leg • Chest • Hip • Knee

  22. Frequency • In the U.S. • 10-20 cases per 100,000 children • Pauciarticular and polyarticular disease occur more frequently in girls • Both sexes are affected with equal frequency in systemic-onset disease • Internationally • Occurs more frequently in certain populations (e.g., Native Americans) from areas like British Columbia and Norway

  23. Mortality • Less than 1% • Often associated with the evolution of disease to manifestations of other rheumatic diseases

  24. Morbidity • Morbidity: • Relates to adverse effects of medications, particularly NSAIDS • Abdominal pain due to gastritis or ulcer disease, hepatotoxicity, renal toxicity • Psychological Morbidity: • Situational depression • Problems functioning in school

  25. Five-year-old Katie Tortorice leads an active, healthy life despite having juvenile rheumatoid arthritis (JRA). Is There a Bright Side? • There are numerous resources for parents: • Websites • Support systems for children • Ongoing research to improve quality of life

  26. Resources: • Paper Media: • Miterski B, Drynda S, Boschow G, Klein W, Oppermann J, Kekow J, Epplen J. 2004. Complex genetic predisposition in adult and juvenile rheumatoid arthritis BMC Genetics 2004, 5:2 1-14 • Web: • www.nlm.nih.gov/medlineplus/juvenilerheumatoidathritis/html • www.painfoundation.org • http://www.med.umich.edu/1libr/pa/umarthri14.htm • http://yourhealth.goodshepherdhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=hw104391

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