What is the most common complication of juvenile rheumatoid arthritis?
Correct Answer A:
Juvenile rheumatoid arthritis (JRA) is a rheumatic disease that begins at or before age 16. Arthritis, fever, rash, adenopathy, splenomegaly, and iridocyclitis are typical of some forms.
Patients with JRA can have joint stiffness, swelling, effusion, pain, and tenderness. JRA may interfere with growth and development. Micrognathia (receded chin) due to early closure of mandibular epiphyses may occur. Iridocyclitis may develop, which may cause conjunctival injection, pain, and photophobia but can be asymptomatic; scarring and glaucoma with band keratopathy can result.
Diagnosis is clinical. Treatment involves NSAIDs and often disease-modifying antirheumatic drugs.
Which of the following is not required for a diagnosis of juvenile rheumatoid arthritis?
Correct Answer C:
Juvenile rheumatoid arthritis (JRA) should be suspected in children with symptoms of arthritis, signs of iridocyclitis, generalized adenopathy, splenomegaly, or unexplained fever lasting more than a few days, or rash. Diagnosis is primarily clinical. Patients suspected of having JRA should be tested for rheumatoid factor (RF), antinuclear antibodies (ANA), and ESR as these tests may be helpful in diagnosing JRA and distinguishing its subtypes. In Still's disease, RF and ANA are absent. In pauciarticular-onset JRA, ANA are present in up to 75%. In polyarticular-onset JRA, RF usually is negative, but in some patients, mostly adolescent girls, it can be positive.
Which one of the following is a manifestation of pauci-articular juvenile rheumatoid arthritis?
Pauci-articular juvenile rheumatoid arthritis (JRA) is more common than polyarticular JRA and systemic JRA. Pauci-articular JRA is further subdivided into two subtypes. Type I is most common in toddlers, especially girls, and can be associated with chronic anterior uveitis, which is often asymptomatic yet potentially destructive. The incidence is higher in children with positive antinuclear antibodies; therefore, regular ophthalmologic surveillance is necessary. Type II is more common in boys and has a later onset. Eye problems are less common.
The presentation of systemic JRA includes prolonged fever, rash, pericarditis or pleuritis, lymphadenopathy, hepatosplenomegaly, anemia, leukocytosis, thrombocytosis, and, of course, arthritis. Glomerulonephritis is uncommon in systemic JRA. Erythema nodosum is not a feature of JRA.
Click to expand