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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

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
  • 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
  • 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

    • 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 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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