http://www.fpnotebook.com/

Juvenile Rheumatoid ArthritisAka: Still's Disease

See Also
1. Rheumatoid Arthritis
Pathophysiology
1. Rheumatoid disease in children
Types
1. Pauciarticular (4 or fewer joints involved)
  1. Age at presentation <8 years
2. Polyarticular (>4 joints involved)
  1. Age at presentation 1-6 or 11-16 years
3. Systemic
  1. Hepatomegaly and Splenomegaly
  2. Lymphadenopathy
  3. High daily Relapsing Fever
  4. Recurrent evanescent rash
Symptoms
1. Pediatric Limp (most common presentation)
2. Pain is minimal compared to inflammatory signs
  1. Increasing pain has Negative Predictive Value for RA
Signs
1. Similar to adult form of Rheumatoid Arthritis
  1. Joint swelling with warmth (not red and hot)
2. Differences from Adult Rheumatoid Arthritis
  1. Higher fever
  2. Rheumatoid Nodules are rare
  3. Pericarditis and valvulitis are more common
  4. Lymphadenopathy and hepatosplenomegaly are common
  5. Arthritis interferes with bone growth
    1. Example: underdeveloped mandible
  6. Uveitis most common juvenile RA eye disorder
    1. Occurs in up to 50% of pauciarticular juvenile RA
      1. Highest risk if ANA positive and recent onset
    2. Asymptomatic in up to 80% of cases
    3. Delayed diagnosis risks Cataracts, Glaucoma, blind
    4. Ophthalmology should follow all with juvenile RA
Differential Diagnosis
1. Lyme Disease
2. Leukemia
3. Septic Arthritis
4. Osteomyelitis
5. Psoriasis
6. Inflammatory Bowel Disease
7. Streptococcal infection
8. Vasculitis
Labs (often non-diagnostic)
1. Rheumatoid Factor
  1. Variably positive, often normal
2. Antinuclear Antibody
  1. May be associated with Uveitis (see above)
3. Erythrocyte Sedimentation Rate (ESR)
  1. High ESR may suggest other diagnoses (e.g. infection)
4. Complete Blood Count
  1. Abnormal in systemic presentation
Diagnosis (diagnosis of exclusion)
1. Chronic arthritis of one or more joints for 6 weeks
2. Other diagnoses excluded
References
1. Schneider (2002) Rheum Dis Clin North Am 28:503

Navigation Tree

Please see the Terms and Conditions. Please also see the privacy statement regarding advertising on this page. Although access to this page is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.