Juvenile Idiopathic Arthritis (JIA)
|
|
- Miles Welch
- 5 years ago
- Views:
Transcription
1 Juvenile Idiopathic Arthritis (JIA) Kaveh Ardalan, MD, MS Division of Rheumatology Ann & Robert H. Lurie Children s Hospital of Chicago Assistant Professor, Pediatrics and Medical Social Sciences Northwestern University Feinberg School of Medicine *Contents adapted from AAP slide deck provided by MSK bootcamp organizers, credit Elizabeth Kessler, MD, MS, Children s Mercy Kansas City
2 I have no relevant financial relationships with the manufacturers of any commercial products and or providers of commercial services discussed in this CME activity I do not intend to discuss an unapproved or investigative use of a commercial product/device in my presentation Only other disclosure: travel reimbursement for a single day biomarker/trial design workshop sponsored by Reveragen
3 Objectives Know the definition of arthritis Recognize the subtypes of juvenile idiopathic arthritis (JIA) Know when to order and how to interpret common rheumatologic labs in a child with joint pain
4 Etiology of Joint Complaints in Childhood Infection Post-infectious/Reactive Orthopedic/Trauma Rheumatic diseases Hematologic Genetic/metabolic/ Malignancy Immunodeficiency Psychogenic/Behavioral
5 Arthritis: Definition Objective signs of inflammation within the joint Swelling or an effusion OR Limitation in range of motion plus: Tenderness to palpation (small joints) Pain with movement OR Petty et al, J Rheumatol Feb;31(2):390-2.
6
7 Inflammatory Arthritis Pain (Arthralgia) Arthritis Arthritis is: Inflammation of the joints. Characterized by swelling, warmth, redness, stiffness, decreased range of motion, pain. Multiple causes: infection, trauma, systemic autoimmune disease, idiopathic Synovium Cartilage NORMAL JIA Inflamed joint lining (synovium) Synovial fluid
8 Joint Complaints: History Is the complaint mechanical or inflammatory? Mechanical: no AM stiffness, pain with activity, improves with rest, no or minimal swelling Inflammatory: AM stiffness, pain improves with activity, associated with swelling, warmth Arthritis!
9 Juvenile Idiopathic Arthritis (JIA) Heterogeneous group of inflammatory disorders Characterized by chronic arthritis Clinical diagnosis
10 Definition of JIA 1. Arthritis in one or more joints for at least 6 weeks Swelling or effusion Limited Range of Motion plus either: Tenderness to palpation OR Pain with Range of Motion 2. Age of onset <16 years 3. Diagnosis of exclusion- other identifiable causes have been ruled out Petty et al, J Rheumatol Feb;31(2):390-2.
11 Indolent onset Symptoms of JIA Stiffness, especially in AM or after a sedentary period Limping or reluctance to walk Difficulty with buttons, snaps, zippers, opening jars and bottles, writing Improves as day progresses or with activity Discomfort without severe or acute pain Swelling (not always noticed)
12 Symptoms of JIA McGhee et al. Pediatrics 2002 Isolated MSK pain without other signs or symptoms is almost never the presenting complaint of chronic arthritis in kids JIA usually presents as joint swelling or limp Children referred with +ANA and/or RF were no more likely to have a chronic inflammatory disease than those who did not include such results as a reason for referral. McGhee et al., Pediatrics Aug;110:354-9
13 History of JIA Classification JRA (1977) JCA (1978) JIA (1997) Pauciarticular Pauciarticular Oligoarticular Persistent Extended Systemic Systemic Systemic Juvenile AS Psoriatic Polyarticular Polyarticular Polyarticular RF+ RF- Enthesitisrelated Psoriatic Undifferentiated
14 Epidemiology Incidence ~10-20/100,000 children Prevalence at least 100/100,000 children Varies by subtype and ethnicity
15 JIA Subtypes Oligoarticular (<5 joints), about 50% Persistent or Extended Polyarticular ( 5 joints) RF negative or positive Systemic Psoriatic Enthesitis Related/Spondyloarthropathy Undifferentiated
16 Oligoarticular JIA Most common form Girls: Boys 3-5:1, peak age 1-4 years Northern European Most common presentation: single swollen knee Limp, worse in AM or after nap May not complain of any pain Otherwise well-appearing
17 Rheumatology Image Library. American College of Rheumatology
18 Complications Flexion Contracture Leg Length Discrepancy
19 Complications Flexion Contracture Leg Length Discrepancy Atrophy Rheumatology Image Library. American College of Rheumatology
20 Uveitis and JIA Usually asymptomatic until damage occurs Chronic in most subtypes Risk factors: younger age, +ANA Up to 20% of oligoarticular JIA Complications: cataracts, glaucoma, blindness Rheumatology Image Library. American College of Rheumatology
21 Recommended Frequency of Ocular Examinations Pediatrics 117: , 2006
22 When do I draw antibodies to diagnose arthritis? NEVER-Arthritis is a clinical diagnosis! Rheumatoid Factor (RF): Negative in 95% of children with arthritis. Positive in many conditions including infections, lupus, liver disease, and malignancy Most common cause of + RF in children is viral infection
23 When do I draw antibodies to diagnose arthritis? Antinuclear Antibody (ANA): Does NOT help with diagnosis of JIA, only to determine risk of uveitis Sensitive for SLE only Positive in liver disease, infections, malignancy, and well children Only 5% of +ANA tests are due to lupus many are in healthy people
24 Polyarticular JIA Girls: Boys 3:1 2 age peaks: Age 1-3: RF negative Later childhood/ adolescence: RF positive Symmetrical, small joints, C-spine, TMJ disease +/- mild systemic disease: anemia, fatigue, ESR More aggressive, requires more medication
25 Symmetrical hand and wrist arthritis in Poly JIA Rheumatology Image Library. American College of Rheumatology
26 C-Spine and TMJ Arthritis
27 TMJs and C-spine Often Involved
28 Spondyloarthropathies Enthesitis Related Arhritis Psoriatic Arthritis Reactive Arthritis Ankylosing Spondylitis Undifferentiated Spondyloarthropathy IBD Associated Arthritis
29 JIA Subtypes Oligoarticular (<5 joints), about 50% Persistent or Extended Polyarticular ( 5 joints) RF negative or positive Systemic Psoriatic Enthesitis Related/Spondyloarthropathy Undifferentiated
30 Common Features Peripheral (esp. knees, hips and ankles), sacroiliac and spine involvement potentially Enthesopathy is common (Achilles, patellar) Sausage digits or Dactylitis Older age, Boys > Girls Acute anterior uveitis HLA B27-related
31 Enthesitis
32 Dactylitis ( Sausage Digit ) Rheumatology Image Library. American College of Rheumatology
33 Inflammatory Eye Disease Conjunctivitis Transient Anterior Uveitis Acute onset, unilateral>bilateral, painful, red eye Can cause permanent vision loss if not treated Does not always parallel arthritis activity
34
35 Psoriatic Arthritis Often precedes the onset of psoriasis in children Clues to diagnosis: 1 st degree relative with psoriasis Nail pitting DIP involvement (33%) Dactylitis (sausage digit) Small joints hands/feet Aggressive, erosive disease Rheumatology Image Library. American College of Rheumatology
36 Psoriatic Arthritis (PsA) Plaque psoriasis (psoriasis vulgaris) is most common skin phenotype in PsA 15% develop psoriasis AFTER onset of arthritis Often within 2 years in kids Some pts may be unaware they have it Scalp, behind ears, navel, nail changes Little relationship between skin severity and arthritis severity
37 Skin Findings Rheumatology Image Library. American College of Rheumatology
38 Enthesitis-Related Arthritis Male > Female Strong association with HLA-B27 Arthritis and enthesitis OR: Arthritis or enthesitis with 2 of the following: SI joint tenderness, +HLA-B27, arthritis in a boy 6 years of age or older, acute anterior uveitis, or 1 st degree relative with spondyloarthritis Peripheral axial disease
39 Systemic Onset JIA: An autoinflammatory disease Clinical Manifestations: Arthritis (may be absent at onset) High grade spiking fever Evanescent rash +/- Adenopathy +/- Hepatosplenomegaly +/- Pleural/pericardial effusion Rheumatology Image Library. American College of Rheumatology
40 Quotidian Fever Evanescent Rash Rheumatology Image Library. American College of Rheumatology
41 Differential Dx of SOJIA Primarily a diagnosis of exclusion Infection Inflammatory bowel disease Malignancy Connective tissue disease - SLE, JDM, PAN Acute Rheumatic Fever Kawasaki s disease
42 SOJIA Prognosis Past: steroid dependant toxicity/ growth failure Current: More targeted therapy: IL-1 and IL-6 blockade Rheumatology Image Library. American College of Rheumatology
43 Macrophage Activation Syndrome (MAS) A life-threatening complication of SOJIA Excessive/Unregulated expansion of Macrophages/ T cells produces a cytokine storm. Increased recruitment and activation of macrophages leads to tissue damage and organ failure Cassidy s textbook of Pediatric Rheumatology Activated macrophage with hemosiderin deposits and a degenerating phagocytosed nucleated cell
44 MAS Acutely ill with purpura, mucosal bleeding Sustained fever Hepatosplenomegaly, adenopathy CNS dysfunction Lethargy with irritability, disorientation, headache, seizures, coma Liver dysfunction: AST, ALT, PT, PTT elevated Pancytopenia Low ESR due to low fibrinogen and liver dysfunction.
45 JIA Treatment Goals of treatment: control inflammation to prevent damage: erosions, contractures, deformities. Once there is damage we have little power to reverse it.
46 JIA Treatment Medications NSAIDS for mild disease Systemic Steroids: try to avoid, do not affect long term outcome Intra-articular steroids Disease modifying agents (DMARDS): methotrexate Biologics: target specific inflammatory mediators TNF alpha, IL-1, IL-6, Tcell costimulatory molecules, others
47 Changes to consider in practice A careful history and exam >> labs in diagnosing arthritis. ANA and RF are prognostic, not diagnostic, tests in JIA. Avoid starting systemic steroids if you do not know the diagnosis.
48 References Petty et al. International League of Associations for Rheumatology Classification of Juvenile Idiopathic Arthritis: Second Revision. J Rheumatol Feb;31(2): McGhee et al. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics Aug;110:354-9 Rheumatology Image Library. American College of Rheumatology Cassidy et al. Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics May;117(5): McGonagle, D. Arthritis Rheum.1999; 42:
Department of Paediatrics Clinical Guideline. Guideline for the child with possible arthritis (joint swelling/pain, loss of function)
Department of Paediatrics Clinical Guideline Guideline for the child with possible arthritis (joint swelling/pain, loss of function) Definition: Juvenile Idiopathic Arthritis (JIA) is defined as arthritis
More informationJuvenileIdiopathicArthritis. Dr Johan Siebert
JuvenileIdiopathicArthritis Dr Johan Siebert 1 NORMAL DIARTHRODIAL JOINT Synovial is a thin membrane enclosing the joint space The joint space contains fluid that bathes the joint and reduces friction
More information8/29/2012. Outline Juvenile idiopathic arthritis. 1. Classification-ILAR. 1. Classification-clinical diagnosis. 1. JIA classification
Outline Juvenile idiopathic arthritis 1. Classification and symptoms (ILAR-International league of Associations for Rheumatology) 2. Imaging J. Herman Kan, M.D. Section chief, musculoskeletal imaging Edward
More informationDepartment of Paediatrics Clinical Guideline
Department of Paediatrics Clinical Guideline The child and young person with possible arthritis (joint swelling and/or pain, loss of function for >4 weeks) Definition: Juvenile Idiopathic Arthritis (JIA)
More informationUpdate on Enthesitis-Related Arthritis, a Subtype of Juvenile Idiopathic Arthritis
Hong Kong Bull Rheum Dis 2010;10:15-19 Review Article Update on Enthesitis-Related Arthritis, a Subtype of Juvenile Idiopathic Arthritis Tsz-Leung Lee Abstract: Keywords: Enthesitis related arthritis (ERA)
More informationJIA and Other Rheumatic Diseases in Children. Norma Liburd, RN-BC, MN
JIA and Other Rheumatic Diseases in Children Norma Liburd, RN-BC, MN Define Juvenile Idiopathic Arthritis (JIA) and discuss the diagnostic criteria. Objectives Identify the subtypes of JIA and discuss
More informationEtiology: Pathogenesis Clinical manifestation Investigation Treatment Prognosis
Etiology: Pathogenesis Clinical manifestation Investigation Treatment Prognosis JIA is the most common rheumatic disease in childhood and a major cause of chronic disability. Etiology: Unknown, but may
More information2/23/18. Disclosures. Rheumatic Diseases of Childhood. Making Room for Rheumatology. I have nothing to disclose. James J.
Making Room for Rheumatology James J. Nocton, MD Disclosures I have nothing to disclose Rheumatic Diseases of Childhood Juvenile Idiopathic Arthritis (JIA) Systemic Lupus Erythematosus (SLE) Juvenile Dermatomyositis
More informationJuvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA)
www.printo.it/pediatric-rheumatology/gb/intro Juvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA) Version of 2016 1. WHAT IS JUVENILE SPONDYLOARTHRITIS/ENTHESITIS- RELATED ARTHRITIS (SpA-ERA)
More informationRheumatology 101 A Pediatrician s Guide
Rheumatology 101 A Pediatrician s Guide Pediatric Staff and Alumni Day 2016 Dawn M. Wahezi, Yonit Sterba, Tamar Rubinstein Disclosures None Pick a Group Group 1 A child with a limp Group 2 ANA To test
More informationObjectives. Joint Pain. Case 1. Rheumatology for the Primary MD (Not just your grandmother s disease) 12/4/2010
Objectives Rheumatology for the Primary MD (Not just your grandmother s disease) Identify when it is appropriate to refer for rheumatologic evaluation Autoimmune/ Inflammatory v. noninflammatory disease
More informationRHEUMATOLOGY OVERVIEW. Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center
RHEUMATOLOGY OVERVIEW Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center What is Rheumatology? Medical science devoted to the rheumatic diseases
More informationwww.fisiokinesiterapia.biz Peak onset between 20 and 30 years Form of spondyloarthritis (cause inflammation around site of ligament insertion into bone) and association with HLA-B27 Prevalence as high
More informationJuvenile Chronic Arthritis
Juvenile Chronic Arthritis Dr. Christa Visser MBChB MMed (Med Phys) Diploma Musculoskeletal Medicine (UK), Member Society of Orthopaedic Medicine (UK) Childhood Arthritis JCA/JIA/JRA Remember Acute rheumatic
More informationTHE MANAGEMENT OF JUVENILE IDIOPATHIC ARTHRITIS
THE MANAGEMENT OF JUVENILE IDIOPATHIC ARTHRITIS Prof Chris Scott PAEDIATRIC RHEUMATOLOGIST UNIVERSITY OF CAPE TOWN RED CROSS WAR MEMORIAL CHILDRENS S HOSPITAL Chronic Arthritis >6wks JIA No other cause
More informationUnderstanding Rheumatoid Arthritis
Understanding Rheumatoid Arthritis Understanding Rheumatoid Arthritis What Is Rheumatoid Arthritis? 1,2 Rheumatoid arthritis (RA) is a chronic autoimmune disease. It causes joints to swell and can result
More informationOverview of Paediatric Investigation Plan (PIP) in Paediatric Rheumatology
Overview of Paediatric Investigation Plan (PIP) in Paediatric Rheumatology Paediatric Rheumatology Expert Meeting, London 4 th December 29 Dr. Richard Veselý, Dr. Emma Sala Soriano Paediatric Investigation
More informationPatient #1. Rheumatoid Arthritis. Rheumatoid Arthritis. 45 y/o female Morning stiffness in her joints >1 hour
Patient #1 Rheumatoid Arthritis Essentials For The Family Medicine Physician 45 y/o female Morning stiffness in her joints >1 hour Hands, Wrists, Knees, Ankles, Feet Polyarticular, symmetrical swelling
More informationCLOSER LOOK AT SpA. Dr. Mohamed Bedaiwi. Consultant Rheumatologist Rheumatology Unit - KKUH
CLOSER LOOK AT SpA Dr. Mohamed Bedaiwi Consultant Rheumatologist Rheumatology Unit - KKUH Closer look at SpA I. Categories II. SIGN & SYMPTOMS III. X-RAY IV. MRI V. MANAGMENT Spondyloarthritis (SpA)
More informationRheumatoid Arthritis. Rheumatoid Arthritis. RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling. Rheumatic Diseases
RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Rheumatic Diseases The prevalence of rheumatoid arthritis in most Caucasian populations approaches 1% among adults 18 and over and
More informationRheumatoid Arthritis. Marge Beckman FALU, FLMI Vice President RGA Underwriting Quarterly Underwriting Meeting March 24, 2011
Rheumatoid Arthritis Marge Beckman FALU, FLMI Vice President RGA Underwriting Quarterly Underwriting Meeting March 24, 2011 The security of experience. The power of innovation. www.rgare.com Case Study
More informationA CRP B FBC C LFT D blood culture E uric acid
1 A 39 year old lady with rheumatoid arthritis is admitted to hospital with a hot, swollen and painful right knee. Which is the most important blood test? A CRP B FBC C LFT D blood culture E uric acid
More informationSeronegative Arthritis. Dr Mary Gayed 25 th April 2018
Seronegative Arthritis Dr Mary Gayed 25 th April 2018 Overview Description of the conditions Discussion of symptoms & investigations that may be required Discussion of management and treatment Questions
More informationIdentification of Psoriatic Arthritis and Ankylosing Spondylitis Early Detection to Facilitate Appropriate Care
Identification of Psoriatic Arthritis and Ankylosing Spondylitis Early Detection to Facilitate Appropriate Care Joy Schechtman D.O. Professor Midwestern University 64C-1876207 Disclosures None 3 64C-1876207
More informationPyrexia of unknown origin? Think still
Pyrexia of unknown origin? Think still Lawrence Owino Okong o, Mmed (UoN); Mphil. (UCT). Lecturer, Department of Paediatrics and Child Health, University of Nairobi. Paediatrician/ Rheumatologist. DISCLAIMER
More informationRheum-inations For the physical therapist
Rheum-inations For the physical therapist All you wanted to know about rheumatology and more! Susan Shenoi MD, MS, RhMsUS Assistant Professor Clinical Director Seattle Children s Hospital 10-2017 Objectives
More informationUltrasound in Rheumatology
Arthritis Research UK Primary Care Centre Winner of a Queen s Anniversary Prize For Higher and Further Education 2009 Ultrasound in Rheumatology Alison Hall Consultant MSK Sonographer/Research Fellow Primary
More information37 year old male with several year history of back pain
37 year old male with several year history of back pain Inflammatory Low Back Pain Clues onset before the age of 40 years insidious onset, chronic (>3 months) pain morning stiffness for longer than 30
More informationSubpopulations within juvenile psoriatic arthritis: A review of the literature
Clinical & Developmental Immunology, June December 2006; 13(2 4): 377 380 Subpopulations within juvenile psoriatic arthritis: A review of the literature MATTHEW L STOLL 1 & PETER A NIGROVIC 1,2, 1 Division
More informationThe Complex/Challenging Spine Patient Steve Wisniewski, M.D. Department of PM&R
The Complex/Challenging Spine Patient Steve Wisniewski, M.D. Department of PM&R 2011 MFMER slide-1 Disclosures None 2011 MFMER slide-2 Learning Objectives Review indications for obtaining imaging studies
More informationPsoriatic Arthritis Shared Decision Making
Psoriatic Arthritis Shared Decision Making Disease Modifying Drug Therapy DMARDs Therapy El Miedany et al. Ann Rheum Dis 74(Suppl2): 1002 DOI: 10.1136/annrheumdis-2015-eular.1410 www.rheumatology4u.com
More informationEXAMINING THE CRUCIAL COALITION BETWEEN DERMATOLOGY AND RHEUMATOLOGY IN PSORIATIC ARTHRITIS
EXAMINING THE CRUCIAL COALITION BETWEEN DERMATOLOGY AND RHEUMATOLOGY IN PSORIATIC ARTHRITIS ACTIVITY 1: EARLY COLLABORATION IN THE TREATMENT OF PSA Key Slides COMMON COMORBIDITIES OF PSORIATIC DISEASE
More informationUpdate - Imaging of the Spondyloarthropathies. Spondyloarthropathies. Spondyloarthropathies
Update - Imaging of the Spondyloarthropathies Donald J. Flemming, M.D. Dept of Radiology Penn State Hershey Medical Center Spondyloarthropathies Family of inflammatory arthritides of synovium and entheses
More informationRheumatoid arthritis and Psoriatic arthritis: a guide for Primary Care. Nina Flavin, MD Rheumatology Confluence Health April 13 th, 2018
Rheumatoid arthritis and Psoriatic arthritis: a guide for Primary Care Nina Flavin, MD Rheumatology Confluence Health April 13 th, 2018 No Disclosures Objectives Recognize early signs of RA/PsA what to
More informationPauciarticular juvenile rheumatoid arthritis: clinical and immunogenetic aspects
Ann. rheum. Dis. (1979), 38, Supplement p. 79 Pauciarticular juvenile rheumatoid arthritis: clinical and immunogenetic aspects CHESTER W. FINK, AND PETER STASTNY From the University of Texas Southwestern
More informationEssential Rheumatology. Dr Ellen Bruce Consultant Rheumatologist CMFT
Essential Rheumatology Dr Ellen Bruce Consultant Rheumatologist CMFT Saving the best for last! Apparently people recall best the first and last thing they re told. Far too difficult to include everything.
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Proposed Health Technology Appraisal Secukinumab for treating ankylosing spondylitis after inadequate response to non-steroidal anti-inflammatory drugs
More informationKelley's Textbook of Rheumatology. 2 Volume Set. Text with Internet Access Code for Premium Consult Edition
Kelley's Textbook of Rheumatology. 2 Volume Set. Text with Internet Access Code for Premium Consult Edition Firestein, G ISBN-13: 9781437717389 Table of Contents VOLUME I STRUCTURE AND FUNCTION OF BONE,
More informationPGALS: Approach to Child with Arthritis. Prof Chris Scott Paediatric Rheumatology
PGALS: Approach to Child with Arthritis Prof Chris Scott Paediatric Rheumatology Introduction In a prospective study from The Royal Hospital for Sick Children, Edinburgh, every 58th child presented with
More informationAccording to the International League of Associations. Juvenile Idiopathic Arthritis. An Update for the Clinician. Philip Kahn, M.D.
152 Juvenile Idiopathic Arthritis An Update for the Clinician Philip Kahn, M.D. Abstract Juvenile idiopathic arthritis (JIA) comprises a collection of all forms of chronic arthritis in childhood with no
More informationA Patient s Guide to Psoriatic Arthritis
A Patient s Guide to Psoriatic Arthritis Glendale Adventist Medical Center 1509 Wilson Terrace Glendale, CA 91206 Phone: (818) 409-8000 DISCLAIMER: The information in this booklet is compiled from a variety
More informationRheumatology and Internal Diseases Clinic of the Central Clinical Hospital in Warsaw 137 Woloska St. WARSAW POLAND prof. Małgorzata Wisłowska
Rheumatology and Internal Diseases Clinic of the Central Clinical Hospital in Warsaw 137 Woloska St. WARSAW 02-507 POLAND prof. Małgorzata Wisłowska MD, PhD 1 Klinika Chorób Wewnętrznych i Reumatologii
More information10/25/2018. Autoimmunity and how to treat it. Disclosure. Why do we get autoimmunity? James Verbsky MD/PhD Pediatric Rheumatology/Immunology
Autoimmunity and how to treat it James Verbsky MD/PhD Pediatric Rheumatology/Immunology Disclosure None I will mention drug names and some brand names but I have no financial interest or any other ties
More informationApproach to Pediatric Uveitis. Paris Tranos PhD,ICO,FRCS OPHTHALMICA Vitreoretinal & Uveitis Service
Approach to Pediatric Uveitis Paris Tranos PhD,ICO,FRCS OPHTHALMICA Vitreoretinal & Uveitis Service Epidemiology Uveitis is the 3 rd leading cause of blindness in USA 5-10% of uveitis cases involve children
More informationSIGNIFICANCE OF ELEVATED INTERLEUKIN-6 LEVEL IN JUVENILE RHEUMATOID ARTHRITIS PATIENTS
SIGNIFICANCE OF ELEVATED INTERLEUKIN-6 LEVEL IN JUVENILE RHEUMATOID ARTHRITIS PATIENTS Essam Tewfik Attwa and S. Al-Beltagy* Rheumatology & Rehabilitation Department, Zagazig University Faculty of Medicine
More informationCIBMTR Center Number: CIBMTR Recipient ID: RETIRED. Today s Date: Date of HSCT for which this form is being completed:
Juvenile Idiopathic Arthritis Pre-HSCT Data Sequence Number: Date Received: Registry Use Only Today s Date: Date of HSCT for which this form is being completed: HSCT type: autologous allogeneic, allogeneic,
More informationERROR CORRECTION FORM
Juvenile Idiopathic Arthritis Pre-HSCT Data Sequence Number: Registry Use Only Date of HSCT for which this form is being completed: HSCT type: autologous allogeneic, allogeneic, syngeneic unrelated related
More informationPhysical examination of the musculosceletal- and nervous system. Pánczél Pál dr.
Physical examination of the musculosceletal- and nervous system in the practice of internal medicine. Pánczél Pál dr. Bursae = sacks of the synovial membrane fulfilled with synovium. Localised between
More informationJeopardy. What s the rash? $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400
Jeopardy Antibodies & more antibodies Aching joints What s the rash? Potpourri Image Challenge $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400 $500 $500
More informationRheumatologic Manifestations of Gastrointestinal Diseases
Rheumatologic Manifestations of Gastrointestinal Diseases NATASHA DEHGHAN, MD, FRCPC CLINICAL ASSISTANT PROFESSOR VASCULITIS CLINIC, MARY PACK ARTHRITIS CENTRE Objectives To discuss a few common rheumatologic
More informationMary Derlacki, FNP. No financial relationships to disclose. Office Rheumatology for the Nurse Practitioner. Rheumatoid Arthritis
Office Rheumatology for the Nurse Practitioner Mary Derlacki, FNP Drs. Cassell and Boren Eugene, OR 541-687-0816 mderlacki@comcast.net No financial relationships to disclose Rheumatoid Arthritis 1% of
More informationJuvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA)
www.printo.it/pediatric-rheumatology/gb/intro Juvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA) Version of 2016 1. WHAT IS JUVENILE SPONDYLOARTHRITIS/ENTHESITIS- RELATED ARTHRITIS (SpA-ERA)
More informationPaediatrica Indonesiana
VOLUME 46 March - April 2006 NUMBER 3-4 Case Report Juvenile rheumatoid arthritis associated with uveitis in a 4-year-old girl Made Sukmawati, Hendra Santoso, Niti Susila Juvenile rheumatoid arthritis
More informationJuvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis?
Butbul Aviel et al. Pediatric Rheumatology 2013, 11:11 RESEARCH Open Access Juvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis? Yonatan Butbul Aviel 1, Pascal Tyrrell 1, Rayfel Schneider
More informationHorizon Scanning Technology Summary. Adalimumab (Humira) for juvenile idiopathic arthritis. National Horizon Scanning Centre.
Horizon Scanning Technology Summary National Horizon Scanning Centre Adalimumab (Humira) for juvenile idiopathic arthritis June 2007 This technology summary is based on information available at the time
More informationMr. OA: Case Presentation
CLINICAL CASES Case 1: Mr. OA OA Mr. OA: Case Presentation 62-year-old lawyer Mild left knee pain for 3 month, but became worse 1 week ago No swelling 1 week earlier: 2-hour walk in the countryside 2 days
More informationWhere has SARA gone? Prof. David Kane Consultant Rheumatologist Beacon & Tallaght Hospitals. Clinical Professor in Rheumatology Trinity College Dublin
Where has SARA gone? Prof. David Kane Consultant Rheumatologist Beacon & Tallaght Hospitals Clinical Professor in Rheumatology Trinity College Dublin 1 Reactive Arthritis Seronegative Asymmetrical Arthritis
More informationChapter 2. Overview of ankylosing spondylitis
Chapter 2 Overview of ankylosing spondylitis The concept and classification of spondyloarthritis The term spondyloarthritis (SpA) comprises AS, reactive arthritis, arthritis/spondylitis associated with
More informationNausheen Khuddus, MD Melissa Elder, MD, PhD
Nausheen Khuddus, MD Melissa Elder, MD, PhD Nausheen Khuddus, MD Pediatric Ophthalmologist and Strabismus Specialist Accent Physicians Gainesville, Florida What Is Uveitis? Uveitis is caused by inflammatory
More information2018 ReachMD Page 1 of 10
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationCase Report Psoriatic Juvenile Idiopathic Arthritis Associated with Uveitis: A Case Report
Case Reports in Rheumatology Volume 2013, Article ID 595890, 4 pages http://dx.doi.org/10.1155/2013/595890 Case Report Psoriatic Juvenile Idiopathic Arthritis Associated with Uveitis: A Case Report Davide
More informationHorizon Scanning Technology Summary. Abatacept (Orencia) for juvenile idiopathic arthritis. National Horizon Scanning Centre.
Horizon Scanning Technology Summary National Horizon Scanning Centre Abatacept (Orencia) for juvenile idiopathic arthritis June 2007 This technology summary is based on information available at the time
More information2004 Health Press Ltd.
... Ankylosing spondylitis Maxime Dougados MD Professor of Rheumatology Hôpital Cochin René Descartes University Paris, France Désirée van der Heijde MD PhD Professor of Rheumatology University Hospital
More informationOutcome in Juvenile Rheumatoid Arthritis in India
Outcome in Juvenile Rheumatoid Arthritis in India Amita Aggarwal, Vikas Agarwal, Debasish Danda and Ramnath Misra From the Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
More informationAxial Spondyloarthritis. Doug White, Rheumatologist Waikato Hospital
Axial Spondyloarthritis Doug White, Rheumatologist Waikato Hospital Disclosures Presentations / Consulting Abbott Laboratories AbbVie MSD Novartis Roche Clinical Trials Abbott Laboratories AbbVie Actelion
More informationWhat is Axial Spondyloarthritis?
Physiotherapist Module 2 What is Axial Spondyloarthritis? How does it apply to physiotherapists? Claire Harris, Senior Physiotherapist, London North West Healthcare NHS Trust Susan Gurden, Advanced Physiotherapy
More informationTreatment modalities Prof Ally 2012
Treatment modalities Prof Ally 2012 Analgesia Types of Pain Nociceptive /neuropathic nociceptive Tissue damage - trauma, inflammation Somatic (musculoskeletal): local pain referred pain Neuropathic pain:
More informationWhen is it Rheumatoid Arthritis When to Refer
When is it Rheumatoid Arthritis When to Refer Nancy A. Brown, DO Spring 2015 When is it Rheumatoid Arthritis When to Refer Learning objectives To review the definition and epidemiology of Rheumatoid Arthritis
More informationJuvenile Idiopathic Arthritis in Adults: Long-Term Observation of Ukrainian Patients
Archive of Clinical Medicine 2017 Vol. 23, Issue 1, E201715 DOI: 10.21802/acm.2017.1.5 Research Article Juvenile Idiopathic Arthritis in Adults: Long-Term Observation of Ukrainian Patients Marta Dzhus
More informationJUVENILE IDIOPATHIC ARTHRITIS A case based study. By: Michael Zhanel. Home for the Summer Program July to August, 2018.
JUVENILE IDIOPATHIC ARTHRITIS A case based study By: Michael Zhanel Home for the Summer Program July to August, 2018 Oakbank, Manitoba Supervisor: Dr. Nader Shenouda Abstract Juvenile idiopathic arthritis
More informationGrowing Pains in Children 1.0 Contact Hour Presented by: CEU Professor
Growing Pains in Children 1.0 Contact Hour Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2008 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution of these
More informationSacroiliac Joint Imaging
Sacroiliac Joint Imaging Jacob Jaremko, MD, PhD Edmonton, Canada SPR, May 2017 Longview, Alberta Overview SI joint anatomy Sacroiliitis pathophysiology Sacroiliitis imaging Disease features Imaging protocols
More informationAssessment of Inflammatory Back Pain: New Concepts in Diagnosis
Assessment of Inflammatory Back Pain: New Concepts in Diagnosis March 2 nd, 2018 Spine Therapy Network Interprofessional Synposium Sheraton Toronto Airport Hotel, Toronto, CANADA Laura Passalent PT, BScPT,
More informationDr Tracey Kain. Associate Professor Ed Gane
Associate Professor Ed Gane New Zealand Liver Transplant Unit Auckland Dr Tracey Kain Consultant Rheumatologist Grace Orthopaedic Centre Tauranga Hospital Tauranga 7:00-7:55 Abbvie Breakfast Session 1.
More informationEffective Health Care Program
Comparative Effectiveness Review Number 28 Effective Health Care Program Disease-Modifying Antirheumatic Drugs (DMARDs) in Children With Juvenile Idiopathic Arthritis (JIA) Executive Summary Background
More informationWhat organ system is involved? What is the pathology? What is the possible etiology?
Johan van Rensburg What organ system is involved? What is the pathology? What is the possible etiology? Genetic Environmental What are the possible complications? How is the patient s functioning impaired?
More informationPsoriasis. Jessica Kaffenberger, M.D. Assistant Professor of Dermatology Division of Dermatology The Ohio State University Wexner Medical Center
Psoriasis Jessica Kaffenberger, M.D. Assistant Professor of Dermatology Division of Dermatology The Ohio State University Wexner Medical Center Learning objectives Recognize the different types of psoriasis
More informationMMS Pharmacology Lecture 2. Antirheumatic drugs. Dr Sura Al Zoubi
MMS Pharmacology Lecture 2 Antirheumatic drugs Dr Sura Al Zoubi Revision Rheumatoid Arthritis Definition (RA): is the most common systemic inflammatory disease characterized by symmetrical inflammation
More informationTypes of osteoarthritis
ARTHRITIS Osteoarthritis is a degenerative joint disease is the most common joint disorder. It is a frequent part of aging and is an important cause of physical disability in persons older than 65 years
More informationaxial spondyloarthritis including ankylosing spondylitis
1 What is spondyloarthritis? Spondyloarthritis is a general term that describes a number of types of inflammatory arthritis which share many articular and extra-articular features. Conditions which fall
More informationDEPARTMENT OF RHEUMATOLOGY
DEPARTMENT OF RHEUMATOLOGY PG Teaching Schedule Theory (8 30 am to 9am) DATE TOPIC PRESENTER FACULTY 01/10/16 Approach to Arthritis Dr. Sandeep Dr. Suma Balan 03/10/16 Cardiovascular risk in Rheumatic
More informationClinical Practice Guideline. Psoriatic Arthritis (PsA) Version
Clinical Practice Guideline Psoriatic Arthritis (PsA) Version 1.1.2016 August 2016 Table of Contents Introduction...5 Diagnosis...6 Patient Assessment... 7 Management of Patients with PsA...8 Peripheral
More informationJuvenile Idiopathic Arthritis
https://www.printo.it/pediatric-rheumatology/ie/intro Juvenile Idiopathic Arthritis Version of 2016 1. WHAT IS JIA 1.1 What is it? Juvenile idiopathic arthritis (JIA) is a chronic disease characterised
More informationEARLY INFLAMMATORY ARTHRITIS. Cristina Tacu Consultant Rheumatologist Brighton and Sussex University Hospital
EARLY INFLAMMATORY ARTHRITIS Cristina Tacu Consultant Rheumatologist Brighton and Sussex University Hospital EIA: Introduction National priority Preventable cause of disability Very common condition High
More informationHistory Taking and the Musculoskeletal Examination
History Taking and the Musculoskeletal Examination Introduction A thorough rheumatologic assessment is performed within the context of a good general evaluation of the patient. The patient should be undressed
More informationINFLIXIMAB Remicade (infliximab), Inflectra (infliximab-dyyb), Renflexis (infliximab-abda)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Remicade, Renflexis and Inflectra are tumor necrosis factor (TNFα) blockers. Tumor necrosis factor is an endogenous protein that regulates a number of physiologic
More informationRegulatory Status FDA- approved indication: Simponi and Simponi ARIA are tumor necrosis factor (TNF) blockers indicated for the treatment of:
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.51 Subject: Simponi / Simponi ARIA Page: 1 of 8 Last Review Date: March 17, 2017 Simponi / Simponi
More informationSeronegative Spondyloarthropathies (SpA)
Seronegative Spondyloarthropathies (SpA) Objectives: Introduction SpA disease information Pathogenesis Clinical features Team Members: Ameera Niazi - Lulwah AlShiha - Qaiss Almuhaideb - Abdullah Hashem
More informationFirst Presentation of Joint Pain
First Presentation of Joint Pain Andrew Harrison Rheumatologist Wellington Regional Rheumatology Unit, HVDHB Bowen Centre, Crofton Downs, Wellington Assoc. Prof. in Medicine, University of Otago Wellington
More informationJoint Injuries and Disorders
Joint Injuries and Disorders Introduction A joint is where two or more bones come together. Your joints include the knees, hips, elbows and shoulders. There are many types of joint disorders, including
More informationJUVENILE SPONDYLOARTHROPATHIES
www.pediatric-rheumathology.printo.it JUVENILE SPONDYLOARTHROPATHIES What is it? The juvenile spondyloarthropathies constitute are a group of chronic inflammatory diseases of the joints (arthritis) and
More informationRheumatoid Arthritis
Rheumatoid Arthritis Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly
More informationA Patient s Guide to Spondyloarthropathies
A Patient s Guide to Spondyloarthropathies 763 Larkfield Road 2nd Floor Commack, NY 11725 Phone: (631) 462-2225 Fax: (631) 462-2240 DISCLAIMER: The information in this booklet is compiled from a variety
More informationCoverage Criteria: Express Scripts, Inc. monograph dated 12/15/ months or as otherwise noted by indication
BENEFIT DESCRIPTION AND LIMITATIONS OF COVERAGE ITEM: PRODUCT LINES: COVERED UNDER: DESCRIPTION: CPT/HCPCS Code: Company Supplying: Setting: Kineret (anakinra subcutaneous injection) Commercial HMO/PPO/CDHP
More informationHorizon Scanning Centre November Secukinumab for active and progressive psoriatic arthritis. SUMMARY NIHR HSC ID: 5330
Horizon Scanning Centre November 2012 Secukinumab for active and progressive psoriatic arthritis. SUMMARY NIHR HSC ID: 5330 Secukinumab is a high-affinity fully human monoclonal antibody that antagonises
More informationAPPLICATION FOR SUBSIDY BY SPECIAL AUTHORITY
APPLICANT (stamp sticker acceptable) Page 1 Fm SA1620 Etanercept INITIAL APPLICATION - juvenile idiopathic arthritis Applications only from a named specialist rheumatologist. Approvals valid f 6 months.
More informationTREAT-TO-TARGET IN RHEUMATOID ARTHRITIS
TREAT-TO-TARGET IN RHEUMATOID ARTHRITIS To receive up to 10 CME credits for this activity, complete the evaluation, attestation and post-test answer sheet (minimum passing grade of 70%) and return all
More informationRheumatoid Arthritis
Rheumatoid Arthritis What is rheumatoid arthritis? Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of
More information