Juvenile idiopathic arthritis is chronic joint inflammation that starts before age 16 and lasts at least 6 weeks with no other cause. It has several types, and some cause silent eye inflammation that can threaten vision.
Key symptoms
- Joint swelling, pain or stiffness, worse in the morning
- Limping or less use of an arm or leg
- In systemic JIA: daily spiking fevers and a salmon-pink rash
- Fatigue and poor growth
What you find on exam
- Warm, swollen joints with limited motion
- Number of affected joints (4 or fewer is oligoarticular)
- Leg length, growth and muscle wasting
- Enlarged liver, spleen and lymph nodes in systemic disease
Tests
- Blood count, ESR and CRP
- ANA (uveitis risk), rheumatoid factor and anti-CCP
- Regular slit lamp eye exams for uveitis
- Joint fluid analysis or imaging to rule out infection
Treatment basics
- NSAIDs such as naproxen
- Joint steroid injections when few joints are involved
- Methotrexate as the main disease-modifying drug
- Biologics such as etanercept, adalimumab or tocilizumab
- Physical therapy and regular eye checks
Red flags
- One hot, very painful joint with fever (septic arthritis)
- Persistent fever with falling blood counts (macrophage activation syndrome)
- Eye redness, pain or vision change
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.