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Juvenile Arthritis: A Small Quiz
Veronica Hackethal, MD
Are you up for a little challenge? Test your diagnostic acumen with these 5 questions.
(Image credit: ©Narikan/Shutterstock.com)
What are the symptoms of juvenile idiopathic arthritis uveitis? Which form of chronic arthritis is most common in North American children? Scroll through the slides for the answers to these and other questions.
Question 1: Which of the following is not a type of juvenile arthritis: fibromyalgia, mixed connective tissue disease, enthesitis-related arthritis, or Hashimoto disease?
ANSWER: Juvenile arthritis comprises a cluster of chronic joint conditions and autoimmune disorders that occur in children before the age of 16. Types of juvenile arthritis include juvenile idiopathic arthritis (JIA), juvenile dermatomyositis, juvenile lupus, juvenile scleroderma, Kawasaki disease, mixed connective tissue disease, and fibromyalgia. Hashimoto disease is an autoimmune disorder that causes hypothyroidism, with a peak age of onset between 40 and 60 years.
Sources
Arthritis Foundation. Juvenile arthritis. Accessed June 28, 2018.
NIDDK. Hashimoto’s disease. Accessed June 28, 2018.
Question 2: Which of the following is not a symptom of systemic onset juvenile idiopathic arthritis: repeating fevers, malar rash, anemia, or salmon-colored rash?
ANSWER: About 10% of children with arthritis have systemic onset JIA, which may affect joints as well as internal organs. It is characterized by repeating, high fevers (often up to 103 degrees F [39.4 degrees C] or higher), along with intermittent salmon-colored rash, anemia, and elevated white blood cell count. Joint symptoms may appear months after the appearance of systemic symptoms. Malar rash can be a symptom of lupus.
Source
ACR. Juvenile arthritis. Accessed June 29, 2018.
ANSWER: Uveitis is one of the most common JIA-associated eye disorders; it affects between 11% and 30% of children with JIA. Symptoms include eye pain, redness, headaches, photophobia, and vision changes. Children with JIA may also have chronic anterior uveitis, which is often asymptomatic but can threaten vision. Regular screening for uveitis is essential for all patients with JIA. Uveitis can also predate the onset of JIA.
Source
Clarke SL, Sen ES, Ramanan AV, et al. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2016;14:27. doi: 10.1186/s12969-016-0088-2.
ANSWER: About 50% to 80% of Caucasian children with chronic arthritis in North America and Europe have oligoarthritis, which affects 4 or fewer joints during the first 6 months of onset. Oligoarthritis is further classified as persistent (confined to 4 joints during the course of the disease) and extended (spreads to more than 4 joints after the first 6 months). Oligoarthritis mostly affects joints of the lower extremities (especially the knee) and is characterized by asymmetric symptoms, early onset before age 6, female predilection, high frequency of antinuclear antibody positivity, and high risk of iridocyclitis.
Source
Giancane G, Consolaro A, Lanni S, et al. Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatol Ther. 2016;3:187-207.
ANSWER: According to criteria from the International League of Association for Rheumatology (ILAR), the diagnosis of juvenile psoriatic arthritis requires arthritis and psoriatic rash. When the rash is missing, diagnosis requires arthritis plus any two of the following: first-degree relative with psoriasis, sausage-like swelling of the digits (dactylitis), and nail pitting (onycholysis). Liver or spleen enlargement can be a symptom of systemic JIA.
Source
Giancane G, Consolaro A, Lanni S, et al. Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatol Ther. 2016;3:187-207.