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From the American College of Rheumatology

Rheumatology for Primary Care
  • Symptoms
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    • ANCA-Associated Vasculitis
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Juvenile Idiopathic Arthritis Case Studies

Home ยป Juvenile Idiopathic Arthritis Case Studies
Juvenile Idiopathic Arthritis Case Studies
  • Case 1

  • Case 2

  • Case 1

A 4 yo WF was brought in by mother for L knee swelling, limp, and decreased activity starting 7 weeks ago.

Physical Exam

  • Afebrile
  • Well-appearing
  • Left knee swelling with small effusion
  • Other joints unremarkable

Diagnostic Workup

  • CBC and CMP unremarkable
  • Normal inflammatory markers
  • ANA positive, RF negative
  • Plain radiographs of L knee normal
Diagnosis

Treatment

  • Start weekly methotrexate
  • Low threshold to add TNF inhibition if incomplete response to methotrexate

Referral

  • Refer for an eye exam to screen for uveitis
  • Case 2

A 12 yo F presents with joint pain in R knee and L hand for 2 months.

Physical Exam

  • Afebrile
  • Well-appearing
  • R knee swelling with small effusion
  • L hand with 3rd digit dactylitis
  • Nail pitting on both hands
  • DIPs of bilateral hands swollen, tender

Diagnostic Workup

  • CBC and CMP unremarkable
  • Normal inflammatory markers
  • Mildly elevated inflammatory markers
  • RF negative
Diagnosis

Treatment

  • Start weekly methotrexate
  • Short course of oral steroids for symptom control
  • Low threshold to add TNF inhibition if incomplete response to methotrexate

Referral

  • Refer for an eye exam to screen for uveitis

Diagnosis

Patient has oligoarticular ANA positive JIA.

Diagnosis

Patient has psoriatic JIA.

Related Links

JIA Overview

 

ACR JIA Treatment Guideline

 

JIA for Pediatric Providers

 

Infographic: Treating JIA

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Primary Care2024-05-21T13:44:44+00:00

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