Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (JIA), formerly known as juvenile rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis (RA) is a symmetric, inflammatory polyarthritis and chronic, progressive, autoimmune disorder. Presentation occurs most commonly in middle-aged women with joint swelling, pain, and morning stiffness (often in the hands). Rheumatoid Arthritis, is a heterogeneous group of inflammatory diseases characterized by inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of 1 or more joints and is the most common pediatric rheumatic disease. Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is classified according to its clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor, and diagnosis is made with examination findings as well as confirmatory lab testing showing evidence of inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and characteristic X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests findings. Treatment is directed at preventing loss of function Loss of Function Inflammation and controlling or limiting joint damage, with a variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables prognosis Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas depending on the type.
Last updated: 11 Nov, 2021
Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis, formerly known as juvenile rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis (RA) is a symmetric, inflammatory polyarthritis and chronic, progressive, autoimmune disorder. Presentation occurs most commonly in middle-aged women with joint swelling, pain, and morning stiffness (often in the hands). Rheumatoid Arthritis, is the most common chronic rheumatological disease in the pediatric population. While there are multiple subgroups with distinct pathogeneses, the key feature is arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis.
Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is a term used to describe a group of inflammatory conditions of the joints affecting children younger than 16 and lasting 6 weeks or longer.
Classification according to symptomatology Symptomatology Scarlet Fever (as per the International League of Associations for Rheumatology):
Oligoarticular | Polyarticular | Systemic | |
---|---|---|---|
% of JIA cases | 50% | 35% | 10% |
Gender Gender Gender Dysphoria | Girls > boys | Girls > boys | Girls = boys |
Age | 2–3 years old, rare > 10 years old | 2–5 years old, 10–14 years old | Any < 16 |
While genetic susceptibility plays a role in JIA, the exact etiology and pathogenesis of the disease is incompletely understood. Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is believed to be caused by an interplay between environmental exposures and genetic predisposition.
Environmental component:
Genetic component:
The presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor of JIA is variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables secondary to the heterogeneous nature of the various subgroups, but there are some common features.
Widespread joint involvement in polyarticular juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (JIA)
Image: “Widespread joint involvement in polyarticular juvenile idopathic arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis” by Kenan Barut et al AL Amyloidosis. License: CC BY 2.5Typical rash Rash Rocky Mountain Spotted Fever in systemic juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (JIA)
Image: “Typical rash Rash Rocky Mountain Spotted Fever in systemic juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis” by Kenan Barut et al AL Amyloidosis. License: CC BY 2.5Salmon-macular rash Rash Rocky Mountain Spotted Fever in systemic juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (JIA)
Image: “Salmon-macular rash Rash Rocky Mountain Spotted Fever in systemic juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis” by Gabriella Giancane et al AL Amyloidosis. License: CC BY 4.0Oligoarticular | Polyarticular | Systemic | |
---|---|---|---|
Number of joints affected | Fewer than 5 | > 5 | Any |
Types of joints affected |
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Systemic features |
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Less frequent uveitis Uveitis Uveitis is the inflammation of the uvea, the pigmented middle layer of the eye, which comprises the iris, ciliary body, and choroid. The condition is categorized based on the site of disease; anterior uveitis is the most common. Diseases of the Uvea |
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Diagnosis of JIA is primarily based on history and physical exam findings. The laboratory data and imaging contribute to the confirmation of the diagnosis and the exclusion of other diseases.
Variable findings related to severity and type of disease; often used to evaluate for other diagnoses:
X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests showing advanced destructive changes in the hips of a systemic juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (JIA) patient
Image: “ X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests showing advanced destructive changes in the hips of a systemic JIA patient” by Gabriella Giancane et al AL Amyloidosis. License: CC BY 4.0Representative images of severe monoarthritis in children diagnosed with oligoarticular juvenile
idiopathic
Idiopathic
Dermatomyositis
arthritis
Arthritis
Acute or chronic inflammation of joints.
Osteoarthritis (JIA):
a)
X-ray
X-ray
Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source.
Pulmonary Function Tests of the hips showed shortening of the left femoral
neck
Neck
The part of a human or animal body connecting the head to the rest of the body.
Peritonsillar Abscess and decreased joint space.
b) MRI with
gadolinium
Gadolinium
An element of the rare earth family of metals. It has the atomic symbol gd, atomic number 64, and atomic weight 157. 25. Its oxide is used in the control rods of some nuclear reactors.
Magnetic Resonance Imaging (MRI) revealed enhancement and mild thickening of the left hip synovium on T2-weighted imaging.
c) MRI of the right wrist demonstrated carpal
synovitis
Synovitis
Inflammation of the synovial membrane.
Rheumatoid Arthritis, marked
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types marrow
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema (BME),
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types
cysts
Cysts
Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.
Fibrocystic Change, and
erosions
Erosions
Corneal Abrasions, Erosion, and Ulcers on T1-weighted imaging.
d)
Non-contrast-enhanced CT
Non-contrast-enhanced CT
Imaging of the Head and Brain (
NCCT
NCCT
Imaging of the Head and Brain) of the left elbow showed
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types
erosions
Erosions
Corneal Abrasions, Erosion, and Ulcers, hyperostosis of the
trochlea
Trochlea
Arm: Anatomy–
olecranon
Olecranon
A prominent projection of the ulna that articulates with the humerus and forms the outer protuberance of the elbow joint.
Arm: Anatomy complex and reduced joint space. White arrows point toward the abnormal findings.
Short tau inversion recovery
Short Tau Inversion Recovery
Magnetic Resonance Imaging (MRI) (
STIR
STIR
Magnetic Resonance Imaging (MRI)) imaging with and without JIA:
Left: 13-year-old girl with juvenile
idiopathic
Idiopathic
Dermatomyositis
arthritis
Arthritis
Acute or chronic inflammation of joints.
Osteoarthritis (JIA),
STIR
STIR
Magnetic Resonance Imaging (MRI) 3
mm
MM
Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies.
Multiple Myeloma
sagittal
Sagittal
Computed Tomography (CT): enlarged dens with bulging dorsal contour (arrow) and narrowing of the
spinal canal
Spinal Canal
The cavity within the spinal column through which the spinal cord passes.
Spinal Cord Injuries at the craniocervical junction (arrowheads)
Right: Normal control image taken of a 13-year-old boy without JIA and normal size of his dens
Magnetic resonance imaging findings of frequently involved joints in juvenile
idiopathic
Idiopathic
Dermatomyositis
arthritis
Arthritis
Acute or chronic inflammation of joints.
Osteoarthritis (JIA):
Bone marrow
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema (BME) appears as a
hyperintense
Hyperintense
Magnetic Resonance Imaging (MRI) signal in spectral attenuated inversion recovery (SPAIR) sequence, reflecting active inflammatory lesion.
a) A SPAIR image of a wrist demonstrates BME on the carpal.
b) A SPAIR image of an ankle shows BME at the tibiofibular joint.
c) A SPAIR image of
sacroiliac joint
Sacroiliac Joint
The immovable joint formed by the lateral surfaces of the sacrum and ilium.
Pelvis: Anatomy shows BME on the left of a sacroiliac (SI) joint.
d) A SPAIR image of a
knee joint
Knee joint
The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation.
Knee Joint: Anatomy shows BME at the distal femur.
Magnetic resonance imaging of a knee in a patient with juvenile
idiopathic
Idiopathic
Dermatomyositis
arthritis
Arthritis
Acute or chronic inflammation of joints.
Osteoarthritis (JIA):
Notice the erosive changes and inflammation demonstrated here.
The primary goal in the management of JIA is to limit Limit A value (e.g., pressure or time) that should not be exceeded and which is specified by the operator to protect the lung Invasive Mechanical Ventilation the extent of joint damage and restrict the loss of function Loss of Function Inflammation. Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is a chronic disease, and inducing remission Remission A spontaneous diminution or abatement of a disease over time, without formal treatment. Cluster Headaches with the least amount of toxicity Toxicity Dosage Calculation is essential.
American College of Rheumatology criteria for complete remission Remission A spontaneous diminution or abatement of a disease over time, without formal treatment. Cluster Headaches: