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What Is Juvenile Rheumatoid Arthritis

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Slide 1 - Group 7 Adrienne Grenier, Koteuaisa Wilson , Maura Comer, Alison Webb
Slide 2 - Group 7
Slide 3 - What Is Juvenile Rheumatoid Arthritis? Arthritis is a disease in a person’s joints that cause swelling and pain where the bones meet each other, resulting in stiffness and loss of motion Juvenile Rheumatoid Arthritis is arthritis in children under 16 years old with inflammation lasting at least 6 weeks
Slide 4 - What Is Juvenile Rheumatoid Arthritis? Juvenile rheumatoid arthritis is different from adult rheumatoid arthritis Kids have different symptoms The damage to bones is different
Slide 5 - How Is Juvenile Rheumatoid Arthritis Different From Adult Rheumatoid Arthritis? Main Difference: Many people with JRA outgrow the illness, while adults usually have lifelong symptoms. Studies estimate that by adulthood, JRA symptoms disappear in more than half of all affected children. Unlike rheumatoid arthritis in an adult, JRA may affect bone development as well as the child's growth.
Slide 6 - Who Gets JRA? About 1 child in every 1,000 develops some type of juvenile arthritis. Approximately 75,000 children in the U.S. Can affect children at any age, but uncommon in the first six months of life
Slide 7 - Why Do Kids Get JRA? Cause is unknown Research suggests a genetic predisposition Triggered by an environmental factor, such as a virus JRA is an autoimmune disease Immune system mistakes healthy cells for harmful ones. Body releases chemicals to fight healthy cells causing pain and swelling.
Slide 8 - Types of Juvenile Rheumatoid Arthritis There are three types JRA. Pauciarticular: fewer than five joints are affected. Usually knees and large joints. Polyarticular: affects five or more joints. Joints on both sides of body are affected. Smaller joints like hands or toes. Systemic JRA: affects many parts of the body. Heart, lungs and liver could be affected as well.
Slide 9 - Signs/symptoms Limping Stiffness when awakening Reluctance to use an arm or leg Reduced activity level Persistent fever Joint swelling
Slide 10 - Signs/symptoms
Slide 11 - Pathophysiology Chronic inflammation of synovium is characterized by B lymphocyte infiltration and expansion. Macrophages and T-cell invasion are associated with the release of cytokines, which evoke synoviocyte proliferation.
Slide 12 - Pathophysiology Continued… 2001 study by Scola et al : Found synovium to contain m-RNA for vascular endothelial growth factor, angiopoietin 1, and their respective receptors This suggests that induction of angiogenesis by products of lymphocytic infiltration may be involved in persistence of disease. The resulting thickened pannus causes joint destruction. In many patients, predominance of cytokines associated with tissue destruction, including interleukin-6 and TNF, suggests the possibility of improved responsiveness to specific biologic agents targeting these factors.
Slide 13 - Healthy Joint Vs. Damaged Joint
Slide 14 - Active Learning:X-Ray of Patient One is normal, and one is a patient with JRA: Can you determine the differences?
Slide 15 - How Is JRA Diagnosed? Complete health history Physical examination to look for joint inflammation, rashes, nodules, signs of internal organ inflammation and/or eye problems Laboratory tests to help rule out other diseases Erythrocyte sedimentation rate Hemoglobin and blood count testing Urinalysis X-rays Tests of joint, blood and tissue fluids to check for infections or inflammation
Slide 16 - Treatment Options Goal: Control symptoms, prevent joint damage, and maintain function 1. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) Motrin or Advil 2. Disease Modifying Drugs (DMARDS) Hydroxychloroquine: Plaquenil Sulfasalazine: Azulfidine Methotrexate: Rheumatrex
Slide 17 - Medication Options JRA is treated similarly to adult RA, although many drugs used to treat RA are not approved for children. Aspirin, in large doses, is generally the first line of defense. If the disease is progressive, anti-rheumatic drugs, such as methotrexate, injectable gold, can be used . The new biologic agent, etanercept (Enbrel), was recently approved for treating JRA. Glucocorticoids, such as prednisone, are usually reserved for children with internal organ or eye inflammation because of the drugs' potential, at high doses, to stunt growth.
Slide 18 - Structure of Medications Plaquenil Azulfidine Rheumatrex
Slide 19 - Medications Continued… Juvenile Rheumatoid Arthritis
Slide 20 - Surgery Rarely used in the early course of disease Function: Relieve pain Release joint contractures Replace a damaged joint
Slide 21 - Exercise Target: Shoulder Neck Lower leg Chest Hip Knee
Slide 22 - Frequency In the U.S. 10-20 cases per 100,000 children Pauciarticular and polyarticular disease occur more frequently in girls Both sexes are affected with equal frequency in systemic-onset disease Internationally Occurs more frequently in certain populations (e.g., Native Americans) from areas like British Columbia and Norway
Slide 23 - Mortality Less than 1% Often associated with the evolution of disease to manifestations of other rheumatic diseases
Slide 24 - Morbidity Morbidity: Relates to adverse effects of medications, particularly NSAIDS Abdominal pain due to gastritis or ulcer disease, hepatotoxicity, renal toxicity Psychological Morbidity: Situational depression Problems functioning in school
Slide 25 - Is There a Bright Side? There are numerous resources for parents: Websites Support systems for children Ongoing research to improve quality of life
Slide 26 - Resources: Paper Media: Miterski B, Drynda S, Boschow G, Klein W, Oppermann J, Kekow J, Epplen J. 2004. Complex genetic predisposition in adult and juvenile rheumatoid arthritis BMC Genetics 2004, 5:2 1-14 Web: