Arthritis in Children

JUVENILE CHRONIC ARTHRITIS (JCA)

Approximately 1:1000 children will develop swelling of one or more joints persisting for more than 3 months with no specific cause found. 50% of these will progress to JCA. 

Aetiology - unknown

• Age under 16 at onset
• Persistent arthritis in one or more joints for 6 weeks (minimum) to 3 months after other aetiologies have been ruled out. E.g. infection, malignancy, blood dyscrasias, Reiter's, hypogammaglobulinaemia

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  Classification by onset (Schaller)

  1. Systemic onset (Still's disease)

  • Age: usually under 5years but can be any age
  • Sex: <5yr female = male; >5yr female > male
  • Fever (high with spikes up to 40°C daily) plus one of the following
• Age: usually under 5years but can be any age
• Sex: <5yr female = male; >5yr female > male
• Fever (high with spikes up to 40°C daily) plus one of the following
  1. Maculopapular rash
  2. Iridocyclitis
  3. RhF +ve
  4. Cervical spine involvement
  5. Pericarditis
  • Generalised lymphadenopathy
  • Hepatomegaly
  • Splenomegaly
  • Sites: knees, wrists, ankle, feet

  2. Polyarticular onset

  • Age: any, even before age 1year!
  • Sex: female > male
  • 5 or more joints involved in the first 3 months
  • Seronegative (RhFactor -ve)

    Sites: knees (60%), wrists, hands

  • Seronegative (RhFactor -ve)
• Age: any, even before age 1year!
• Sex: female > male
• 5 or more joints involved in the first 3 months

• Seronegative (RhFactor -ve)

  Sites: knees (60%), wrists, hands

  • RhFactor +ve

    Older children (9-10 years) with persistent activity and rapid joint destruction affecting mainly the hands and feet.

  Older children (9-10 years) with persistent activity and rapid joint destruction affecting mainly the hands and feet.

  3. Pauciarticular (most common)

  • 4 or less joints involved in the first 3 months
  • Type I

    Younger onset <6yr, with females mainly affected. ANA +ve. Danger because of development of iridocyclitis. Presence of ANA related to eye involvement.

  • Type I
• 4 or less joints involved in the first 3 months

• Type I

  Younger onset <6yr, with females mainly affected. ANA +ve. Danger because of development of iridocyclitis. Presence of ANA related to eye involvement.

  • Type II

    Older onset 9yr+, with males mainly affected. Association with HLA-B27.