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Arthritis in Children

Matt Smith, 2006

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

Diagnostic Criteria

  • 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

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
  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
  • RhFactor +ve

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


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