{"id":19735,"date":"2024-06-04T09:24:16","date_gmt":"2024-06-04T08:24:16","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=19735"},"modified":"2024-12-30T15:09:21","modified_gmt":"2024-12-30T15:09:21","slug":"juvenile-idiopathic-arthritis-jia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-rheumatology\/juvenile-idiopathic-arthritis-jia\/","title":{"rendered":"Juvenile idiopathic arthritis (JIA)"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>Juvenile idiopathic arthritis (JIA) is arthritis of unknown aetiology that begins before the 16th birthday and persists for at least 6 weeks; other known conditions are excluded.&nbsp; Key clinical features include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Early morning joint stiffness (EMS)<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Synovitis (seen as joint swelling)<\/li>\n\n\n\n<li>Enthesitis (inflammation at entheses)<\/li>\n\n\n\n<li>Loss of range of joint movement, often with pain at end of range<\/li>\n\n\n\n<li>Arthralgia<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Joint Deformity<\/li>\n\n\n\n<li>Associated with uveitis which can be asymptomatic \u2013 we will refer to Ophthalmology once diagnosed<\/li>\n<\/ul>\n\n\n\n<p>Pain is not a common presenting feature of JIA.&nbsp;<\/p>\n\n\n\n<p>The chief differentials for a swollen joint are infection (septic arthritis or osteomyelitis), malignancy (particularly leukaemia or bone tumours) and trauma.<\/p>\n\n\n\n<p>Blood tests looking for JIA are often normal and are therefore only helpful in excluding other causes of joint pain\/swelling rather than JIA itself.&nbsp; It is for this reason that in a well child with suspected JIA, who is being referred to Rheumatology, we would advise not doing any investigations at the point of referral.<\/p>\n\n\n\n<p>BSR guidance states that healthcare practitioners should refer all children and young people with suspected JIA to the paediatric rheumatology team within <strong>6 weeks<\/strong> of the onset of symptoms<\/p>\n\n\n\n<p>There are several different sub types of JIA (see table below) with oligoarticular JIA being the most common.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Oligoarthritis<\/strong><\/td><td>Affects four or fewer joints, typically the large ones (knees, ankles, elbows). Most common subtype of JIA.<\/td><\/tr><tr><td><strong>Polyarthritis<\/strong><\/td><td>Affects five or more joints, often on both sides of the body (both knees, both wrists, etc.). May affect large and small joints<\/td><\/tr><tr><td><strong>Systemic<\/strong><\/td><td>Affects the entire body (joints, skin and internal organs). Symptoms may include a high spiking fever (103\u00b0F or higher) that lasts at least two weeks and intermittent rash<\/td><\/tr><tr><td><strong>Psoriatic arthritis (PsA)<\/strong><\/td><td>Joint symptoms and a scaly rash behind the ears and\/or on the eyelids, elbows, knees, belly button and scalp.<\/td><\/tr><tr><td><strong>Enthesitis-related<\/strong><\/td><td>Also known as spondyloarthritis. Affects where the muscles, ligaments or tendons attach to the bone (entheses)<\/td><\/tr><tr><td><strong>Undifferentiated<\/strong><\/td><td>Symptoms don\u2019t match up perfectly with any of the subtypes, but inflammation is present in one or more joints<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Systemic onset JIA (SOJIA)<\/strong><strong> is a serious medical condition that can be life-threatening and is associated with macrophage activation syndrome (MAS)<\/strong> \u2013 <strong>urgent discussion with Paediatric Rheumatology is advised<\/strong>.&nbsp; SOJIA can be difficult to identify early in the course (as arthritis may not be present initially). It may present in many different ways and a high index of suspicion is needed. The disease is present equally in males and females with no preferential age of onset.<\/p>\n\n\n\n<p><strong>Diagnosis of SOJIA<\/strong><\/p>\n\n\n\n<p>Requires presence of arthritis accompanied or preceded by daily-spiking fever plus one or more of the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Evanescent non-fixed macular rash (pink rash that characteristically coincides with fever peaks)<\/li>\n\n\n\n<li>Hepatomegaly or splenomegaly<\/li>\n\n\n\n<li>Generalised lymphadenopathy<\/li>\n\n\n\n<li>Serositis<\/li>\n<\/ul>\n\n\n\n<p>The arthritis is often symmetrical and polyarticular and can be absent at onset and develop during disease course.<\/p>\n\n\n\n<p><strong>M.A. &amp; J.H. 04-06-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p>GPs. Secondary care.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p>All suspected cases of JIA should be referred urgently to Paediatric Rheumatology via sci gateway.&nbsp;<\/p>\n\n\n\n<p>Suspected cases of SOJIA should be discussed urgently with the Paediatric Rheumatology team via switchboard.&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p>SCI gateway (<em>Royal Hospital for Children and Young People &gt; Rheumatology<\/em>)<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care  Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.versusarthritis.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">Versus Arthritis | A future free from arthritis<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Juvenile idiopathic arthritis (JIA) is arthritis of unknown aetiology that begins before the 16th birthday and persists for at least 6 weeks; other known conditions are excluded.&nbsp; Key clinical features include: Pain is not a common presenting feature of JIA.&nbsp; The chief differentials for a swollen joint are infection (septic arthritis or osteomyelitis), malignancy<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":18217,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1106],"class_list":["post-19735","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-juvenile-idiopathic-arthritis-jia"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-paediatric-rheumatology\/https-apps-nhslothian-scot-refhelp-juvenile-idiopathic-arthritis-jia\/\" rel=\"tag\">Juvenile idiopathic arthritis (JIA)<\/a>","rttpg_excerpt":"Information Juvenile idiopathic arthritis (JIA) is arthritis of unknown aetiology that begins before the 16th birthday and persists for at least 6 weeks; other known conditions are excluded.&nbsp; Key clinical features include: Pain is not a common presenting feature of JIA.&nbsp; The chief differentials for a swollen joint are infection (septic arthritis or osteomyelitis), malignancy","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/19735","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=19735"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/19735\/revisions"}],"predecessor-version":[{"id":22327,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/19735\/revisions\/22327"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18217"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=19735"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=19735"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}