Juvenile R heumatoid A rthritis .

1. Juvenile Rheumatoid Arthritis. Sakharova Inna. Ye., MD, Univ. assistant

2. Juvenile Rheumatoid Arthritis (JRA) is classified as a connective tissue disease. It is a chronic systemic inflammatory disorder that damages the joints of the body.

3. Clinical features of JRA: • Joint pain, stiffness, and swelling: These are the most common symptoms of JRA, but many children do not recognize, or do not report, pain. Stiffness and swelling are likely to be more severe in the morning. • Loss of joint function: Pain, swelling, and stiffness may impair joint function and reduce range of motion. Some children are able to compensate in other ways and display little, if any, disability. Severe limitations in motion lead to weakness and decreased physical function and sometimes to invalidization.

4. Limp: A limp may indicate a particularly severe case of JRA, although it also may be due to other problems that have nothing to do with arthritis, such as an injury. In JRA, a limp often signals knee involvement. • Eye irritation, pain, and redness: These symptoms are signs of eye inflammation. The eyes may be sensitive to light. In many cases, however, eye inflammation has no symptoms. If the inflammation is very severe and not reversed, it can cause loss of vision. The most common types of eye inflammation in JRA are uveitis and iritis. The names refer to the part of the eye that is inflamed.

5. Recurrent fevers: Fever is high and comes and goes with no apparent cause. Fever may “spike” (go high) as often as several times in one day. • Rash: A light rash may come and go without explanation.

6. Myalgia (muscle aches): This is similar to that achy feeling that comes with the flu. It usually affects muscles throughout the whole body, not just one part. • Lymph node swelling. Swollen lymph nodes are noticed most often in the neck and under the jaw, above the clavicle, in the armpits, or in the inguinal region. • Weight loss. This is common in children with JRA. It may be due to the child’s simply not feeling like eating.

7. Growth problems: Children with JRA often grow more slowly than average. Growth may be unusually fast or slow in an affected joint, causing one arm or leg to be longer than the other. General growth abnormalities may be related to having a chronic inflammatory condition such as JRA or to the treatment, especially glucocorticoids

8. Diagnosticcriteria of JRA: Clinical signs: • Arthritis more than 3 months (in Europe), more than 6 weeks (in USA). • Next joint arthritis in 3 months and more after the first joint affection • Symmetrical affection of small joints • Effusion in joint cavity (under the capsule) • Joint contracture.

9. Diagnosticcriteria of JRA: • Tendosynovitis or bursitis. • Muscular atrophy. • Morning stiffness of joints. X-ray signs: • Osteoporosis. • Articular cavities narrowing • Bone growth disturbances

10. The main JRA subsets:

11. Laboratory testsin JRA • ANA(antinuclear antibody) • RF(Rheumatoid factor ) • CRP (C-reactive protein) • ESR (erythrocyte sedimentation rate) • CCP (Cyclic Citrullinated Peptide Antibody) test

12. Nonsteroidal anti-inflammatory drugs (NSAIDs)

13. Slow-acting anti-rheumatic drugs (SAARDs)

14. Gold compaunds

15. Slow-acting anti-rheumatic drugs (SAARDs)

16. Immune System Medications(Cytostatics)

17. Other medications • Biologic Agents, which blocks the protein TNF Etanercept (Enbrel) Infliximab (Remicade) • Glucocorticoid Drugs (Dexamethasone, Methylprednisolone, Cortef, Prednisolone and Prednisone) • Analgesics(acetaminophen [Tylenol, Panadol], tramadol [Ultram])

18. Very important parts of treatment for juvenile arthritis: • Therapeutic exercises • Sports and Recreational Activities • Splints

19. Very important parts of treatment for juvenile arthritis: • Morning Stiffness Relief • Diet • Eye Care • Dental Care • Surgery