Monday, August 9, 2010

2010 JA Conference Notes - JIA Diagnosis

Our daughter’s diagnosis is Juvenile Idiopathic Arthritis (JIA) - Oligo - Extended
Persistent Oligo means the disease stays at 4 or less joints
Extended means the disease progresses to more than 4 joints, after six months

The definition for a JIA Diagnosis is:
Child less than 16 years old
Swelling in one or more joints for six weeks or more

The diagnosis of JIA can be frustrating and take some time. The reason for this is that all other causes have to be ruled out to consider it JIA.

0.5/1 in 1000 kids nationwide have JIA. In Wisconsin it is much more prevalant, more like 1 in 350 kids.

Oligo subtype of JIA is normally easier to treat than the subtypes that come on harder sooner. (More than 4 joints in the first six months). Extended Oligo is normally harder to treat than persistent.

It is extremely rare to develop Systemic JIA if you didn’t present with the disease at diagnosis.

JIA affecting the fingers is a hallmark of a tougher disease. The swelling normally doesn’t get better with first or second line drugs (nsaids)

Rheumatoid Factors (RF) are antibodies made by the immune system. Sometimes they are made for no reason. They can signal an immune system in overdrive. RF proteins survive for an average of 3 months. In order to be RF+ two consecutive positive tests need to be performed at least three months apart.

Antinuclear antibody (ANA) is a marker for iritis and uveitis. 70% of children under the age of 6 have ANA+. If you don’t develop Iritis or Uveitis in 4 years it is highly unlikely that you will in the future.

Anemia - The body is so busy fighting inflammation that it is not doing the maintenance that it should be. (The body isn’t making as many blood cells)

Fever of Unknown origin (FUO) can be a sign of systemic JIA. If a fever persists for more than two weeks, it’s generally not infectious disease related.

When joints are swollen for a period of months the affected leg can grow longer than the leg that is not affected. When this is observed it is a sign that the disease has been there for some time because it is a persistent but slow affect of JIA. If your child walks funny check their leg lengths, we have met a lot of folks that had lifts put in the child’s shoes. If you need a lift in your child’s shoe find a good shoe repair shop. Our’s was able to put lifts in our daughters shoes without you being able to tell that there was one. They did a great job! Normally over time the legs will even out in length if the swelling is taken care of.

When ankles are swollen the affected foot can be smaller than the arthritis free one. Also over time the bones can grow larger and fuse together. Inflammation for a long period of time makes major changes in the affected joints. The bones within the joints grow larger and eventually they grow so large that the joint can no longer pivot.

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