Overview
What is juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of juvenile idiopathic arthritis (JIA)?
Which physical findings are characteristic of juvenile idiopathic arthritis (JIA)?
How is juvenile idiopathic arthritis (JIA) categorized?
What is the role of lab testing in the diagnosis of juvenile idiopathic arthritis (JIA)?
Which radiographic findings suggest juvenile idiopathic arthritis (JIA)?
Which imaging studies may be performed in the diagnosis of juvenile idiopathic arthritis (JIA)?
Which procedures that may be performed in the diagnosis of juvenile idiopathic arthritis (JIA)?
What are the treatment approaches to juvenile idiopathic arthritis (JIA)?
What are the ACR criteria for complete remission of juvenile idiopathic arthritis (JIA)?
What are the ACR recommendations for treatment selection in juvenile idiopathic arthritis (JIA)?
Which surgical procedures performed in the treatment of juvenile idiopathic arthritis (JIA)?
What is juvenile rheumatoid arthritis (JRA)?
Which organizations have developed classification criteria for juvenile idiopathic arthritis (JIA)?
How does the ACR criteria classify juvenile idiopathic arthritis (JIA)?
How does the ILAR criteria classify juvenile idiopathic arthritis (JIA)?
How does the EULAR criteria classify juvenile idiopathic arthritis (JIA)?
What is the pathophysiology of juvenile idiopathic arthritis (JIA)?
What is the role of the immune system in the pathogenesis of juvenile idiopathic arthritis (JIA)?
What are risk factors for juvenile idiopathic arthritis (JIA)?
What is the incidence of juvenile idiopathic arthritis (JIA) in the US?
What is the global incidence of juvenile idiopathic arthritis (JIA)?
What are the approximate frequencies of the various forms of juvenile rheumatoid arthritis (JRA)?
How does the prevalence of juvenile idiopathic arthritis (JIA) vary by sex?
How does the prevalence of juvenile idiopathic arthritis (JIA) vary by age?
What is the prognosis of juvenile idiopathic arthritis (JIA)?
What are the prognostic factors of a worse outcome for juvenile idiopathic arthritis (JIA)?
How does systemic-onset juvenile idiopathic arthritis (JIA) progress following treatment?
What is the prognosis of oligoarticular juvenile idiopathic arthritis (JIA)?
What are the adverse risks of biologics in the treatment of juvenile idiopathic arthritis (JIA)?
Presentation
What do patients with juvenile idiopathic arthritis (JIA) present with?
How are joints affected by juvenile idiopathic arthritis (JIA)?
How does juvenile idiopathic arthritis (JIA) affect quality of life?
What are the signs and symptoms of systemic-onset juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of psoriatic juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of enthesitis-related juvenile idiopathic arthritis (JIA)?
How is juvenile idiopathic arthritis (JIA) diagnosed?
What is the role of lab testing in the diagnosis of juvenile idiopathic arthritis (JIA)?
How is juvenile idiopathic arthritis (JIA) defined?
Which findings are characteristic of synovitis in juvenile idiopathic arthritis (JIA)?
What is required for a definite diagnosis of systemic-onset juvenile idiopathic arthritis (JIA)?
Which physical findings suggest systemic-onset juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of oligoarticular juvenile idiopathic arthritis (JIA)?
What is the significance of a finding of anterior uveitis in juvenile idiopathic arthritis (JIA)?
What are the diagnostic criteria for enthesitis-related juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of polyarticular juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of psoriatic juvenile idiopathic arthritis (JIA)?
What are the signs and symptoms of enthesitis-related juvenile idiopathic arthritis (JIA)?
What is the most common manifestation of enthesitis-related juvenile idiopathic arthritis (JIA)?
What are the diagnostic criteria for enthesitis-related juvenile idiopathic arthritis (JIA)?
How is undifferentiated juvenile idiopathic arthritis (JIA) diagnosed?
What are the complications of systemic-onset juvenile idiopathic arthritis (JIA)?
What are the complications of oligoarticular and psoriatic juvenile idiopathic arthritis (JIA)?
What are the complications of polyarticular juvenile idiopathic arthritis (JIA)?
What are the complications of enthesitis-related juvenile idiopathic arthritis (JIA)?
DDX
How is leukemia differentiated from juvenile idiopathic arthritis (JIA)?
How is postinfectious arthritis differentiated from juvenile idiopathic arthritis (JIA)?
How is septic arthritis differentiated from juvenile idiopathic arthritis (JIA)?
How is thrombocytopenia differentiated from juvenile idiopathic arthritis (JIA)?
How is acute rheumatic fever differentiated from juvenile idiopathic arthritis (JIA)?
What is the significance of weight loss in the evaluation of juvenile idiopathic arthritis (JIA)?
How is juvenile idiopathic arthritis (JIA) differentiated from inflammatory bowel disease?
What are the differential diagnoses for Juvenile Idiopathic Arthritis?
Workup
How is juvenile idiopathic arthritis (JIA) diagnosed?
What is the role of inflammatory markers in the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of blood testing in the diagnosis of juvenile idiopathic arthritis (JIA)?
Which tests should be performed prior to medical therapy for juvenile idiopathic arthritis (JIA)?
Which lab testing is performed to rule out a diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of urinalysis in the diagnosis of juvenile idiopathic arthritis (JIA)?
How is macrophage-activating syndrome (MAS) identified in juvenile idiopathic arthritis (JIA)?
What is the role of radiography in the workup of juvenile idiopathic arthritis (JIA)?
What are the limitations of radiography for the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of CT scanning in the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of MRI in the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of ultrasonography in the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of bone scanning in the diagnosis of juvenile idiopathic arthritis (JIA)?
What is the role of echocardiography in the diagnosis of juvenile idiopathic arthritis (JIA)?
Which procedures are performed in the diagnosis of juvenile idiopathic arthritis (JIA)?
Treatment
What are the treatment goals for juvenile idiopathic arthritis (JIA)?
How is the therapy success monitored in juvenile idiopathic arthritis (JIA)?
What are the ACR criteria for complete remission of juvenile idiopathic arthritis (JIA)?
What is the ACR recommended basis of treatment selection for juvenile idiopathic arthritis (JIA)?
What are the ACR treatment guidelines for systemic juvenile idiopathic arthritis (JIA)?
When is inpatient care indicated for juvenile idiopathic arthritis (JIA)?
What are the benefits to exercise in the management of juvenile idiopathic arthritis (JIA)?
What is the treatment for leg length discrepancies caused by juvenile idiopathic arthritis (JIA)?
What is the role of surgery in the treatment of juvenile idiopathic arthritis (JIA)?
What is the role of synovectomy in the treatment of juvenile idiopathic arthritis (JIA)?
When is osteotomy indicated in the treatment of juvenile idiopathic arthritis (JIA)?
When is arthrodesis indicated in the treatment of juvenile idiopathic arthritis (JIA)?
Which patient groups are most likely to develop uveitis due to juvenile idiopathic arthritis (JIA)?
What are treatment options for uveitis secondary to juvenile idiopathic arthritis (JIA)?
What is the role of dietary modifications in the treatment of juvenile idiopathic arthritis (JIA)?
What is the role of activity modifications in the treatment of juvenile idiopathic arthritis (JIA)?
Which specialist consultation are needed for the management of juvenile idiopathic arthritis (JIA)?
What long-term monitoring is needed for the management of juvenile idiopathic arthritis (JIA)?
Medications
Which medications are used for the treatment of juvenile idiopathic arthritis (JIA)?
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Patient with active polyarticular arthritis. Note swelling (effusions) of all proximal interphalangeal (PIP) joints in addition to boney overgrowth. Also note lack of distal interphalangeal joint (DIP) involvement. The patient has interosseus muscle wasting (observed on the dorsum of the hands), and subluxation and ulnar deviation of the wrists are present. Image courtesy of Barry L. Myones, MD.
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Wrist radiographs of the patient with active polyarticular arthritis shown in Media file 2. Note severe loss of cartilage in the intercarpal spaces and the radiocarpal space of the right wrist. A large erosion is present in the articular surface of the ulnar epiphysis. The view of the left wrist shows boney ankylosis involving the lateral 4 carpal bones with sparing of the pisiform. Erosions are present in the distal radius and ulna. Almost a loss of cartilage has occurred between the radius and ulna and the carpus. Narrowing of the carpal/metacarpal joints is present. Image courtesy of Barry L. Myones, MD.
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Close-up of the proximal interphalangeal (PIP) effusions in the patient with active polyarthritis shown in Media files 2 and 3. Synovial thickening and effusion, as well as boney overgrowth, are present at the PIP joints bilaterally. Image courtesy of Barry L. Myones, MD.
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Patient with inactive polyarticular arthritis. Long-term sequelae of polyarticular disease includes joint subluxation (note both wrists and thumbs), joint contractures (at proximal interphalangeal joints [PIPs] and distal interphalangeal joints [DIPs]), boney overgrowth (at all PIPs), and finger deformities (eg, swan-neck or boutonniere deformities). Image courtesy of Barry L. Myones, MD.
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Hand and wrist radiographs of the patient with inactive polyarticular arthritis shown in Media file 5. Long-term sequelae of polyarticular disease includes periarticular osteopenia, generalized increase in the size of epiphyses, accelerated bone age, narrowed joint spaces (especially at the fourth and fifth proximal interphalangeal joints [PIPs] bilaterally), boutonniere deformities (at left third and fourth interphalangeal joints), and medial subluxation of the first metacarpophalangeal joints (MCPs) bilaterally. Flattening and erosion of the radial carpal articular surface is present in both wrists. Mild narrowing of the joint spaces exists at the carpometacarpal joints and intercarpal rows bilaterally, with sclerotic change of the intercarpal row (right > left). The trapezium and trapezoid may be fused bilaterally. Image courtesy of Barry L. Myones, MD.
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Sequelae of chronic anterior uveitis. Note the posterior synechiae (weblike attachments of the pupillary margin to the anterior lens capsule) of the right eye secondary to chronic anterior uveitis. This patient has a positive antinuclear antibodies (ANAs) and initially had a pauciarticular course of her arthritis. She now has polyarticular involvement but no active uveitis. Image courtesy of Carlos A. Gonzales, MD.
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One set of suggested algorithms for the treatment of patients with juvenile arthritis. This should not be considered dogmatic because treatment is not standardized and remains empiric and, at times, controversial.
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Systemic juvenile idiopathic arthritis (JIA) rash.
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Child with pericardial effusion due to systemic onset juvenile idiopathic arthritis (JIA).
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Flexion and extension views of C-spine in child with poorly controlled polyarticular juvenile idiopathic arthritis (JIA).
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Temporal-mandibular joint (TMJ) MRI postgadolinium infusion. Abnormal increased uptake indicative of synovitis in child with polyarticular juvenile idiopathic arthritis (JIA).
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Eighteen-month-old girl with arthritis in her right knee. Note the flexion contracture of that knee.
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Ankylosis in the cervical spine at several levels due to long-standing juvenile rheumatoid arthritis (also known as juvenile idiopathic arthritis).
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Widespread osteopenia, carpal crowding (due to cartilage loss), and several erosions affecting the carpal bones and metacarpal heads in particular in a child with advanced juvenile rheumatoid arthritis (also known as juvenile idiopathic arthritis).
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(A) T2-weighted MRI shows high signal in both hips, which may be due to hip effusions or synovitis. High signal intensity in the left femoral head indicates avascular necrosis. (B) Coronal fat-saturated gadolinium-enhanced T1-weighted MRI shows bilateral enhancement in the hips. This indicated bilateral active synovitis, which is most pronounced on the right. Because the image was obtained with fat saturation, the hyperintensity in both hips is pathologic, reflecting an inflamed pannus.
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- History of Arthritis in 4 or Fewer Joints
- History of Arthritis in 5 or More Joints
- Active Sacroiliac Arthritis
- Systemic Arthritis with Active Systemic Features and without Active Arthritis
- Systemic Arthritis with Active Arthritis and without Active Systemic Features
- Hospital Admission
- Exercise and Other Nonpharmacologic Therapy
- Surgical Treatment
- Treatment of Macrophage Activation Syndrome
- Treatment of Uveitis
- Diet and Activity
- Consultations
- Long-Term Monitoring
- Show All
- Medication
- Questions & Answers
- Media Gallery
- Tables
- References