ARTRITIS IDIOPATICA JUVENIL PDF

Etiopatogenia La AIJ es una enfermedad autoinmune, en cuya patogenia se llamada complejo mayor de histocompatibilidad CMH , lo- implican diferentes componentes del sistema inmune2. La calizada en el cromosoma 6p Las citoquinas proinflamatorias se encuentran elevadas existen otros muchos factores predisponentes. En la fase inicial de La enfermedad se define como: la enfermedad los pacientes refieren artromialgias, para des- 1. Persistente durante al menos 6 semanas. En las que se hayan excluido otras causas conocidas de dillas, tobillos y carpos.

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Two subtypes of oligoarticular arthritis exist: persistent oligoarthritis, where no more than 4 joints are affected throughout the whole disease course; and extended oligoarthritis, where more than 4 joints are affected after the first 6 months of disease. Patients in this subtype are often young, typically aged 2—3 years and with a female preponderance.

The most commonly involved joint is the knee, but other affected joints may include the ankles, wrists, elbows and others. Polyarticular Rheumatoid Factor Negative Arthritis[ edit ] Arthritis involving 5 or more joints in the first 6 months of disease.

In this subtype of arthritis both small and large joints are typically involved, usually in an asymmetric pattern. Involved joints may include the jaw Temperomandibular joint and cervical spine. Children with polyarticular JIA are also at risk of developing Uveitis and should also be monitored by an optometrist or ophthalmologist. Polyarticular Rheumatoid Factor Positive Arthritis[ edit ] Arthritis involving 5 or more joints in the first 6 months, with a positive Rheumatoid factor on at least 2 occasions, tested 3 months apart.

In this subtype of arthritis both small and large joints are typically involved, usually in a symmetric pattern. This subtype of arthritis behaves in a very similar fashion to the equivalent adult disease Rheumatoid arthritis. It affects mostly adolescent girls and is typically more aggressive than other forms of JIA in terms of joint damage and the development of erosions in surrounding bone.

The clinical presentation is similar to that of Rheumatoid arthritis with a symmetric polyarthritis typically involving the PIP and MCP joints. Children may develop rheumatoid nodules and similar complications to adult disease, including joint erosions. It is also associated with one or more of the following: a transient erythematous rash that often occurs in association with the fever; enlargement of multiple lymph nodes; the presence of an enlarged liver or spleen; or the presence of Serositis inflammation surrounding the heart, lungs or abdominal cavity.

The rash is often discrete, salmon-pink macules of different sizes which may migrate to different parts of the body. Patients with Systemic-onset juvenile idiopathic arthritis are at risk of a potentially life-threatening complication called Macrophage activation syndrome. Enthesitis is tenderness at the insertion sites of tendons, ligaments and fascia caused by inflammation. This type of arthritis is common in adolescent boys and typically affects large joints in the lower limbs, including the hips.

It can also involve the Sacroiliac joint and the spine. Psoriatic Arthritis[ edit ] This subtype of arthritis is diagnosed by the combination of arthritis and Psoriasis or, arthritis and at least 2 of the following: Dactylitis , nail-pitting, or Psoriasis in a first-degree relative.

Psoriatic arthritis is typically asymmetric in its pattern of joint involvement and can involve both large and small joints. A characteristic feature of this type of arthritis is dactylitis, which is caused by inflammation of the flexor tendon and synovium, resulting in sausage-shaped swelling of an entire finger or toe.

Undifferentiated Arthritis[ edit ] This subtype is diagnosed when a child has JIA that fulfils criteria in none of the subtypes, or in 2 or more of the subtypes of JIA.

Differential diagnosis[ edit ] There are several other disorders and diseases that present with symptoms like JIA. These causes include, but are not limited to, infectious for example Septic arthritis or Osteomyelitis and post-infectious conditions Reactive arthritis , Acute rheumatic fever , and in some geographic areas Lyme disease ; hematologic and neoplastic diseases such as leukemia or bony tumors; and other connective tissue diseases such as Systemic lupus erythematosus.

For the Systemic-onset form of JIA, the differential diagnosis also includes Kawasaki disease and periodic fever syndromes. Rarely, skeletal dysplasias or metabolic diseases, such as Farber disease and forms of Mucopolysaccharidosis , may also mimic JIA, as they may present with joint swelling, joint restriction, stiffness, and pain.

Patients with Farber disease typically have subcutaneous nodules and a hoarse or weak voice due to growth of nodules on the larynx. Treatment[ edit ] The major emphasis of the treatment of JIA is helping the child or young person regain normal levels of physical and social functioning by controlling inflammation and extra-articular symptoms.

Clinical remission should be the primary target for all patients and treatment should be adjusted until this is achieved. Optimising physical and social functioning is accomplished via a two-pronged approach: non-pharmacological strategies such as physical therapies, pain management strategies, and social supports; and the swift use of medication to control inflammation and extra-articular symptoms.

Pharmacological treatments[ edit ] Major advances in drug treatments have been made over recent decades. Intra-articular steroid injections and Nonsteroidal anti-inflammatory drugs NSAIDs , including ibuprofen and naproxen, are often used as first line treatments for most subtypes of JIA.

NSAIDs have useful analgesic and anti-inflammatory properties, although they are generally unlikely to lead to remission if used in isolation. Systemic corticosteroids oral or intravenous , such as prednisolone, dexamethasone and methylprednisolone, are highly effective treatments, however their utility is limited by their side-effect profile. They have a role in short-term disease control for some patients, but should generally be avoided as long-term treatment options.

These medications target specific inflammatory cytokines such as Tumor necrosis factor alpha etanercept, adalimumab, infliximab , Interleukin 6 tocilizumab and Interleukin 1 anakinra. There are several research groups exploring novel treatments for patients with JIA. Several new biologic DMARDs anti-interleukinA, anti-interferon-gamma and targeted small molecules Janus kinase inhibitors have shown promise in other diseases and are currently undergoing clinical trials in patients with JIA.

Evidence regarding the efficacy of complementary and alternative treatments in managing JIA is generally lacking. There are no controlled studies looking at dietary interventions for JIA and current recommendations suggest a healthy, balanced, age-appropriate diet that meets all nutritional needs.

Non-pharmacological treatments[ edit ] The optimal approach to treating a child with JIA typically involves a team of medical professionals, which may include but is not limited to paediatric rheumatologists, paediatric rheumatology nurses, general paediatricians, general practitioners, adult rheumatologists, physical therapists, occupational therapists, podiatrists, psychologists, social workers, pharmacists, ophthalmologists and orthopaedic surgeons.

The multidisciplinary team work together to provide the child and their family with support and education about JIA, strategies to promote age-appropriate self-sufficiency and help the child to adapt and adjust to any challenges they face.

There are many ways to make daily tasks easier or more manageable. One of the key ways the multidisciplinary team helps children with JIA is to involve them, and their families, in the decision-making process regarding their treatment and rehabilitation.

In young children with JIA, symptoms may result in either delay or regression in developmental milestones such as walking, running or climbing. Upper limb function may also be affected. Members of the multidisciplinary team can perform developmental assessments to identify deficits and guide treatments. The information gathered can be shared with schools and child care facilities. One of the key ways occupational or physical therapists help young children with JIA is by developing a home therapy program based around play.

Exercises are prescribed by both PTs and OTs to increase the range a child can move a joint, to strengthen the muscles around a joint, to decrease pain and stiffness and to prevent further limitations in their joint movements. OTs and PTs can provide children with age-appropriate games and activities to allow the children to practice their exercises while playing and socializing with friends.

Examples are crafts, swimming, and sports. Surgery is only used to treat the most severe cases of JIA and is now rarely required. They usually work with the child and family to develop a home exercise program which changes over time as the child makes progress. Arthritis in childhood can be associated with muscle weakness and wasting around the affected joints.

It can also lead to low bone density, which may predispose to osteoporosis and fractures in adulthood. Getting regular exercise is an important part of the management of JIA to promote bone and muscle health.

Consensus is that children with JIA should be following national public health standards of physical activity and participating in moderate fitness, flexibility, and strengthening exercises, compatible with their abilities and disease restrictions. E, sports such as basketball or football and strengthening exercises. Bone strengthening activities build up muscles; by having the muscles push and pull against the bone, the bones themselves get stronger.

This can include things like playing on climbing equipment, swinging on monkey-bars, using weights, carrying groceries, skipping or running. In fact, there is evidence to show that both low and high-intensity exercise programs result in improved physical function and reduced pain in children with JIA.

Guidelines indicate that children with JIA should be encouraged to be physically active and can safely participate in sports without disease exacerbation. Those with actively inflamed joints should limit activities within pain limits, then gradually return to full activity following a disease flare.

These serial casts are usually applied over days to weeks. Active strengthening and lengthening is used in conjunction with serial casting for optimal results. Some children may benefit from foot orthotics to support and correct body position and function. Orthotics maintain biomechanical alignment and may reduce discomfort in the legs and back when children participate in physical activities such as sports. Occupational Therapy[ edit ] Many children with JIA will benefit from seeing an Occupational Therapist, who can provide strategies to assist in to maximizing independence in activities and routines.

This may include suggestions around types of clothes or shoes to wear; using ergonomic cutlery or pens to make writing and eating easier; and learning how to conserve energy and protect joints while completing routine tasks. Pacing is an important skill, so that children learn to make the most of their energy by prioritizing jobs, learning to break tasks down into smaller components, to be flexible with changing plans and to build up muscle strength and stamina to maximize fitness.

If prescribed, these are only for short periods of time as prolonged splinting can result in further muscle weakness. Resting splints, usually worn at night, are now rarely prescribed. Nursing care in JIA[ edit ] Paediatric rheumatology nurses provide health and medical care for children and young people with rheumatic disease, from birth through to late adolescence.

They are employed by many large hospitals, and also in some private rheumatology practices. Paediatric rheumatology nurses have specialist skills and experience which allow them to work with children, young people and their families to address any concerns, fears and problems, including those around treatment and medication administration.

Paediatric rheumatology nurses work holistically with the entire family unit. The diagnosis of a rheumatological condition can be devastating for the child and parents, and often has a ripple effect on the family unit. Education on paediatric rheumatology conditions and medications is a core part of the role of the paediatric rheumatology nurse.

Nurses also work with patients to help them accept and adjust to the hospital setting, and prepare them for medical treatments and procedures in the event they are required.

They often provide advice and instruction at a time of disease flare or other acute medical issue. Many of the medications used in paediatric rheumatology suppress the immune system. It is imperative that an understanding of all facets of all prescribed medications is imparted to the patient age dependant and their families. This is usually the combined role of the rheumatologist and the rheumatology nurse.

Self Management[ edit ] Pain is the most common and often the most distressing symptom of JIA although some children with JIA do have joint inflammation without any pain at all. Pain can occur even when children are receiving effective doses of therapies which are managing their underlying disease.

Pain has been found to negatively impact all aspects of quality of life and is associated with a reduction in physical, social and emotional functioning. Children who have higher levels of pain, tend to have reduced levels of socialization, school attendance and participation in activities. Increased pain is also correlated with poor sleep and higher fatigue in children with JIA. The causation of pain in JIA is multifactorial.

There are disease related factors, which relate to the inflammatory process, and anatomical or biomechanical changes that are associated with joint swelling and joint disease. There are psychological factors around dealing with stress, coping with a chronic illness and managing anxiety or depression which can influence the perception of pain and the degree of functional impairment.

There are also social factors, which relate to family and peer relationships, parental distress and social and financial supports. Coping with chronic illness during childhood and adolescence is associated with significant stress that can put children at risk for emotional or behavioural distress and can interfere with compliance and adherence to treatment regimes.

Managing JIA can be a challenge and it is important to have a toolbox of skills, supports and strategies to draw upon to manage the ups and downs of having a chronic illness.

There are many things that can help children with JIA to grow up to have full and active lives. This in turn affects concentration, energy levels, memory and mood. Most children need between 8 to 12 hours of sleep to feel refreshed, depending on age.

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La AIJ es una enfermedad relativamente rara que afecta a entre 1 y 2 personas cada 1. Nuestro sistema inmunitario nos protege de las infecciones que ocasionan diversos microorganismos como los virus o las bacterias. La AIJ no es una enfermedad hereditaria, ya que no puede transmitirse directamente de padres a hijos. Hay diversas formas de AIJ. Normalmente es una forma grave de artritis.

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Presencia de HLA-B27 positivo. Familiar de primer grado afecto de psoriasis. La AIJ tiene una etiopatogenia multifactorial. Figura 1. Artritis de rodilla derecha en paciente con AIJ oligoarticular. Figura 2. Figura 3.

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