Juvenile Idiopathic Arthritis - Changing Times, Changing Terms, Changing Treatments.

Abstract

1. Susan Shenoi, MBBS, MS* 1. *Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine & Seattle Children’s Hospital, Seattle, WA * Abbreviations: ALT: : alanine aminotransferase ANA: : antinuclear antibody AST: : aspartate aminotransferase CARRA: : Childhood Arthritis and Rheumatology Research Alliance CBC: : complete blood cell CRP: : C-reactive protein DMARD: : disease-modifying antirheumatic drug ERA: : enthesitis-related arthritis ESR: : erythrocyte sedimentation rate FDA: : Food and Drug Administration HLA: : human leukocyte antigen IAS: : intraarticular corticosteroid injection IL: : interleukin ILAR: : International League of Associations for Rheumatology IV: : intravenous JIA: : juvenile idiopathic arthritis MAS: : macrophage activation syndrome NSAID: : nonsteroidal anti-inflammatory drug PVNS: : pigmented villonodular synovitis RF: : rheumatoid factor SJIA: : systemic juvenile idiopathic arthritis TMJ: : temporomandibular joint TNF: : tumor necrosis factor The management of juvenile idiopathic arthritis (JIA) has changed radically over the last few decades. This article provides an update on identification of JIA, complications of the condition, and common management strategies to help practitioners treat affected children in conjunction with other specialists as part of a multidisciplinary team. After completing this article, readers should be able to: 1. Recognize the clinical findings associated with the various categories of juvenile idiopathic arthritis (JIA). 2. Recognize the laboratory findings associated with the different categories of JIA and its complications. 3. Formulate a differential diagnosis for children with joint pain. 4. Recognize the long-term complications associated with JIA. 5. Plan the appropriate management of JIA while recognizing adverse effects of some therapies. Arthritis is a common cause of disability in childhood. In children, the condition previously was known as juvenile chronic arthritis or juvenile rheumatoid arthritis. Currently, the preferred name for childhood arthritis is juvenile idiopathic arthritis (JIA) because this term denotes the idiopathic or unknown cause of the condition. The exact incidence and prevalence of JIA is unknown and likely varies across the world. The estimated incidence and prevalence of JIA in the United States is approximately 14 per 100,000 children (95% confidence interval: 10–18) and 113 per 100,000 (95% confidence interval: 55–155), respectively. (1) JIA is believed to have a multifactorial etiology, with both genetic and nongenetic (ie, environmental) contributing causes. Due to the paucity of practicing pediatric rheumatologists, pediatricians or family practice physicians often are “on the front line” for initial identification and treatment of JIA. This article focuses on key points for diagnosis and initial evaluation of JIA and provides an overview of treatment. According …