| The oligoarticular type of juvenile arthritis, which has | | | | joints of the hand. There may be loss of the articular |
| fewer joints affected, is indicated by four or fewer | | | | cartilage with areas of cartilage erosion and in some |
| joints being inflamed with the ankles and knees, the | | | | cases a fusion across the joint, with thickening of the |
| larger joints, being more commonly affected. The | | | | synovial membranes and effusions within the joints. |
| children present as feeling well but may exhibit a limp | | | | Long term changes in a joint which is arthritic can |
| when they walk. If the child appears to only have | | | | include partial dislocation, joint stiffness and |
| one hip affected then the diagnosis should be | | | | contractures, bony enlargement and deformities, |
| questioned as they are more likely to have a | | | | especially of the fingers. Other findings can be loss of |
| different condition such as Perthes disease. Chronic | | | | bone stock around the joints and narrowing of the |
| arthritic problems can lead to weakness and wasting | | | | joint spaces due to cartilage loss. |
| of the main extensor muscles of the knee, with | | | | A reduction of extension in the neck may not |
| tightness of the hamstrings leading to a flexion | | | | produce any symptoms but it is important to identify |
| contracture of the knee. Asymmetric arthritis just in | | | | this as it can indicate arthritic changes in the cervical |
| one leg can produce a leg length discrepancy. | | | | spine which can lead to partial dislocation (subluxation) |
| The polyarticular type of juvenile arthritis, which has | | | | of the upper neck bones, a potentially dangerous |
| a larger number of joints affected, is indicated by | | | | situation. The neck bones can also fuse together |
| five or more joints becoming inflamed in a | | | | along the posterior structures. The jaw joints, the |
| symmetrical manner, the same joints being inflamed | | | | tempero-mandibular joints, may also be affected and |
| on both sides. A low level fever may be present and | | | | lead to reduced amount of growth in the lower jaw |
| if the joints are badly limited in terms of range of | | | | with inability to open the mouth as wide as normal. |
| motion there is likely to be weakness of the | | | | There may also be involvement of the eyes in the |
| associated muscles and a limitation in function. | | | | inflammatory process. |
| Examining the patient thoroughly is crucial to | | | | Management of patients with juvenile arthritic |
| determine if they do have the diagnosis of juvenile | | | | diseases is best accomplished by a multi-disciplinary |
| arthritis, where they have particular difficulties and | | | | team which include treatments of patient and family |
| which form of arthritis they possess. | | | | education, occupational therapy, physiotherapy, |
| To establish the diagnosis of arthritis on the | | | | school functioning and medication. Little success can |
| examination of a joint an effusion (swelling fluid within | | | | be gained by using individual treatments on their own. |
| the joint capsule) must be present along with other | | | | If the patient is reviewed at regular intervals then |
| likely signs and symptoms such as redness, warmth, | | | | the medication can be routinely adjusted so that the |
| pain and limited joint movement. Effusion of a joint | | | | number of arthritic joints and the stiffness in the |
| may not be apparent in many joints such as the hips | | | | morning reduces until there are no symptomatic |
| but in those cases the limited joint motions and pain | | | | joints. The multidisciplinary team typically consist of a |
| will be apparent. The diagnosis may not be apparent | | | | nurse, occupational therapist, social workers, |
| initially as the arthritis can come on at the time of the | | | | physiotherapist and a paediatric rheumatologist. |
| fevers and the rash but it can also be delayed for | | | | Surgical care is not typically engaged although joint |
| some months. Liver and lymph node enlargement can | | | | injections of steroids may be useful in some cases. |
| be evident with tender muscles on examination. One | | | | Joint replacement can be used for hip or knee |
| joint is often affected in the fewer joint form of | | | | arthritis in patients with polyarticular arthritis but is |
| juvenile arthritis. | | | | usually delayed until skeletal maturity means bone |
| In the many jointed polyarticular form of juvenile | | | | growth has stopped. Activity is usually encouraged as |
| arthritis the weight bearing joints are typically | | | | long term rest is unhelpful and increased activity |
| affected in a symmetrical pattern, as are the small | | | | indicates a better outcome. |