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Published on : Mar 14, 2014
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Slide 1 - Working Together to Help Children with Juvenile Idiopathic Arthritis Lori B. Tucker, M.D. Clinical Associate Professor in Pediatrics Division of Rheumatology BC Children’s Hospital Vancouver BC
Slide 2 - To provide general background about juvenile idiopathic arthritis (JIA). To establish relevance of JIA Module for family physicians. To review key material in the JIA Module. Objectives for This Talk
Slide 3 - Improve the early recognition of juvenile arthritis. Provide clinicians with tools to assist in the diagnosis of MSK complaints in children. Suggest pathways for referral of children with MSK complaints when needed, and increase awareness among GPs of accessibility of care for children and teens with arthritis in BC. Goals for the JIA MSK Module
Slide 4 - 11 year old girl, living in a rural community in BC Develops gradual stiffness in fingers, wrists and knees, with increasing pain. No swelling is seen. Unable to play the violin, difficulty with writing at school. Seen in local ER and walk in several times. Investigation done….and told everything was normal. Xrays; ANA, RF, ESR done……. 8 months after symptom onset, grandparents take her to their family dr. Urgent referral to pediatric rheumatology is placed. Patient is seen in 3 weeks- dx: polyarticular JIA Active joint count 18; unable to make a fist. A true story……MC
Slide 5 - ppt slide no 5 content not found
Slide 6 - What is Juvenile Idiopathic Arthritis? Most common childhood chronic disease causing disability. About 7/100,00 newly diagnosed children with JIA per year. Prevalence about 1/1,000 children = 1,000 children in BC with JIA. 7 subtypes. Disease begins at any time during childhood or adolescence.
Slide 7 - Child under 16 years old At least one joint with objective signs of arthritis: Swelling, or two of the following: pain with movement, warmth of the joint, restricted movement, or tenderness Duration of more than 6 weeks Other causes have been excluded (ex. Infections, Lupus and other connective tissue diseases, malignancies) Juvenile Idiopathic Arthritis
Slide 8 - Have you seen a case of JIA or other autoimmune disease in a child? Have you seen a child with a limp or MSK pain? Why do I need to learn about JIA? I will never see a case of this…….
Slide 9 - 81% of Canadians say they know almost nothing about JIA. Only 30% had ever seen, read, or heard anything about JIA. Compared with 45-70% for other chronic conditions such as asthma, cancer, diabetes, HIV, CF, cerebral palsy, heart conditions. Ipsos-Reid, 2010 Few know that JIA even exists….
Slide 10 - All kids with JIA have fevers. All kids with JIA have rashes. A child with joint pain (but no arthritis) must have JIA. All arthritis is painful. If a child has a positive rheumatoid factor, they must have arthritis. If x-rays are normal, there is no arthritis. Common Diagnostic Myths About Arthritis in Childhood……
Slide 11 - The JIA Module:Helping you with Diagnostic Pathway Child with MSK complaint presents to GP office Medical history Physical examination Red Flags?? Laboratory testing and imaging as indicated
Slide 12 - Assess general health status. Child friendly approach. Do a complete physical examination. All joints should be examined, even if complaints are referred to only one. Keep developmental norms in mind. Physical Examination of the Child with an MSK Problem
Slide 13 - Child is unwell. Fever, weight loss, weakness Bone pain or night pain. Regression of motor milestones. Significant functional disability. Child not ambulating Child missing school or activities Watch for Red Flags
Slide 14 - Evidence based screening MSK assessment for school aged children based on the adult GALS (Gait, Arms, Legs, Spine) screen Validated with excellent sensitivity and specificity Basic clinical maneuvers completed in an average of 2 minutes http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals.aspxFoster HE. Arthritis Care Res 2006.55:709-716. What is pGALS?
Slide 15 - Documentation of pGALS Screen
Slide 16 - Gait Observe the child walking and turning The pGALS Screen
Slide 17 - The pGALS Screen Arms
Slide 18 - The pGALS Screen Legs
Slide 19 - The pGALS Screen Spine
Slide 20 - Child or teen with joint pain, swelling, stiffness, or dysfunction which has lasted more than 2 weeks and is unrelated to trauma. Child with signs and symptoms suggestive of a generalized connective tissue disease or autoimmune condition. Systemic lupus, dermatomyositis, vasculitis, periodic fever syndromes When to Refer to a Pediatric Rheumatologist……
Slide 21 - General pediatric evaluation is often an excellent interim step. What if you are not really sure….
Slide 22 - Vancouver: David Cabral, Lori Tucker, Jaime Guzman, Kristin Houghton, Kim Morishita, Ross Petty Pediatric physiotherapist, occupational therapist Social worker Pediatric rheumatology nurses Penticton: Katherine Gross, M.D. Nurse and physio/OT Victoria: Roxana Bolaria M.D. Nurse and physio/OT Where can I refer my patients for help?Pediatric Rheumatology Teams in BC
Slide 23 - What about when my patient does have JIA? Work together as partners to provide care. Assist in arranging community services. Administer injectable medications i.e. methotrexate Monitor for side effects of medications. Assist parents with school issues if necessary. Provide immunizations, or modify schedule as outlined by pediatric rheumatology team.
Slide 24 - Thank you Questions