Orthopedic conditions in Peds
What are the primary clinical manifestations of Juvenille Idiopathic Arthritis?
Joint swelling, pain, stiffness
Morning stiffness
muscle atrophy; weakness; poor muscle endurance
acute or chronic iridocyclitis (most common in oligoarticular JIA)
systemic manifestations (may be severe in systemic JIA; mild to moderate in
polyarticular JIA)
What are the secondary clinical manifestations of Juvenile Idiopathic Arthritis?
limited joint motion; soft tissue contracture
fatigue
decreased aerobic capacity; reduced exercise tolerance
growth abnormalities (local and general)
osteopenia;
osteoporosis (increased risk with long-term use of oral corticosteroids)
difficulties with ADLs
possible activity/participation restrictions
What are the primary and secondary clinical manifestations of Juvenile
Idiopathic Arthritis?
Gait deviations
Signs and symptoms of Systemic Arthritis
pleuritis, pericarditis, myocarditis, hepatosplenomegaly, and
lymphadenomegaly
,fever, rash, and pericarditis often subside after the initial disease period but
may recur during periods of exacerbation of the arthritis
Signs & Symptoms of Oligoarthritis
*Children with this type have the best prognosis for joint preservation and
function, but may develop contractures during active disease and later
degenerative arthritis
low-grade inflammation in four or fewer joints, most often the knee, followed in
frequency by the ankles and elbows
hip and small joints of hand usually spared
joint may be swollen and warm but may not always be painful
systemic signs are unusual but about 30% of children develop iridocyclitis (an
asymptomatic inflammation of the eye that may lead to functional blindness)
Signs & Symptoms of Polyarthritis
symmetrical and often affects both large and small joint
joints are swollen and warm but rarely red
systemic symptoms are usually mild and include low-grade fever and mild to
moderate hepatosplenomegaly and lymphadenopathy
~19% develop iridocyclitis
Signs & Symptoms of Polyarthritis-RF positive
rheumatoid nodules on the elbows, tibial crests, and fingers and may develop
erosive synovitis early in the disease
course
Characteristics of Systemic Arthritis
frequency: 4%-17%
● Sex ratio: F>M
, ● diagnostic marker is a spiking fever of 102.2F or higher that occurs once or
twice daily for at least 2 weeks, with a rapid return to normal or below between
spikes
● fever accompanied by a typical evanescent rash that is most often found on
the trunk or limbs but may be seen on the face, palms, and soles of the feet
● systemic disease may precede arthritis by
several months or year
Charcteristics of Oligoarthritis
Knee joint most commonly affected
Frequency: 4%-17%
Sex ratio:
F>>>M
Must have their eyes examined by an ophthalmologist at diagnosis and,
depending on the risk, every 3-4 or 6-2 mo.
Characteristics of Polyarthritis
defined as arthritis in five or more joints
onset is often insidious, with arthritis noted in progressively more joints
RF-positive:
Frequency:
2-7%
Sex ratio:
F>>M
follows disease course similar to that in adults with RA
RF-negative:
Frequency:
11-28%
Sex ratio: F>>M
fewer joints are affected
What are the primary clinical manifestations of Juvenille Idiopathic Arthritis?
Joint swelling, pain, stiffness
Morning stiffness
muscle atrophy; weakness; poor muscle endurance
acute or chronic iridocyclitis (most common in oligoarticular JIA)
systemic manifestations (may be severe in systemic JIA; mild to moderate in
polyarticular JIA)
What are the secondary clinical manifestations of Juvenile Idiopathic Arthritis?
limited joint motion; soft tissue contracture
fatigue
decreased aerobic capacity; reduced exercise tolerance
growth abnormalities (local and general)
osteopenia;
osteoporosis (increased risk with long-term use of oral corticosteroids)
difficulties with ADLs
possible activity/participation restrictions
What are the primary and secondary clinical manifestations of Juvenile
Idiopathic Arthritis?
Gait deviations
Signs and symptoms of Systemic Arthritis
pleuritis, pericarditis, myocarditis, hepatosplenomegaly, and
lymphadenomegaly
,fever, rash, and pericarditis often subside after the initial disease period but
may recur during periods of exacerbation of the arthritis
Signs & Symptoms of Oligoarthritis
*Children with this type have the best prognosis for joint preservation and
function, but may develop contractures during active disease and later
degenerative arthritis
low-grade inflammation in four or fewer joints, most often the knee, followed in
frequency by the ankles and elbows
hip and small joints of hand usually spared
joint may be swollen and warm but may not always be painful
systemic signs are unusual but about 30% of children develop iridocyclitis (an
asymptomatic inflammation of the eye that may lead to functional blindness)
Signs & Symptoms of Polyarthritis
symmetrical and often affects both large and small joint
joints are swollen and warm but rarely red
systemic symptoms are usually mild and include low-grade fever and mild to
moderate hepatosplenomegaly and lymphadenopathy
~19% develop iridocyclitis
Signs & Symptoms of Polyarthritis-RF positive
rheumatoid nodules on the elbows, tibial crests, and fingers and may develop
erosive synovitis early in the disease
course
Characteristics of Systemic Arthritis
frequency: 4%-17%
● Sex ratio: F>M
, ● diagnostic marker is a spiking fever of 102.2F or higher that occurs once or
twice daily for at least 2 weeks, with a rapid return to normal or below between
spikes
● fever accompanied by a typical evanescent rash that is most often found on
the trunk or limbs but may be seen on the face, palms, and soles of the feet
● systemic disease may precede arthritis by
several months or year
Charcteristics of Oligoarthritis
Knee joint most commonly affected
Frequency: 4%-17%
Sex ratio:
F>>>M
Must have their eyes examined by an ophthalmologist at diagnosis and,
depending on the risk, every 3-4 or 6-2 mo.
Characteristics of Polyarthritis
defined as arthritis in five or more joints
onset is often insidious, with arthritis noted in progressively more joints
RF-positive:
Frequency:
2-7%
Sex ratio:
F>>M
follows disease course similar to that in adults with RA
RF-negative:
Frequency:
11-28%
Sex ratio: F>>M
fewer joints are affected
