RHEUMATOID ARTHRITIS (Juvenile Idiopathic Arthritis)
Autoimmune conditions affecting the joints
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Oligoarthritis- 4 or lesser joints within first 6 months
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Persistent Arthritis- 4 joints or less affected throughout the disease process
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Extended Arthritis- Affecting more than 4 joints after the first 6 months
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Polyarthritis- 5 or more joints with arthritis in the first 6 months
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RF positive
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RF negative
Systemic arthritis
Arthritis with or preceded by daily fever for at least 3 days with one or more of following
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Erythematous rash
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Lymphadenopathy
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Hepatomegaly or splenomegaly
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Serositis
Arthritis or Psoriasis with at least 2 of following
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Dactylitis
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Nail pitting
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Psoriasis in the first-degree relative
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Sacroiliac joint tenderness of inflammatory lumbosacral pain
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HLA B27 antigen
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Onset after age 6 years in a male
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Acute (symptomatic) anterior uveitis
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HLA B27-associated disease in a first-degree relative
SYMPTOMS
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Pain, swelling and redness around joints.
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Stiffness in joints in the morning which lasts for more than 30 minutes
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Fatigue
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Number of joints involved
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Age at onset
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Fever
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Family history of psoriasis, eye conditions, inflammatory bowel disease, ankylosing spondylitis
EXAMINATION
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Rash
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Hepatomegaly/ splenomegaly
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Lymphadenopathy
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Psoriasis signs.
These tests are used for classification of disease or establish activity of the disease
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Full blood count
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Erythrocyte sedimentation rate (ESR)
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C-reactive protein (CRP)
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HLA B27
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RF antibody
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CCP Antibody
Medications used to reduce inflammation in the joints, relieve pain, prevent joint damage
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NSAIDs are first-line treatment. Consider using a proton-pump inhibitor drug along with them
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Methotrexate – takes 6-12 weeks to effect after commencing treatment
Remember- Baseline investigations are needed prior to the commencement of Methotrexate and require regular monitoring
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Leflunomide
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Hydroxychloroquine
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Sulfasalazine
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Infliximab