What do you need to make a diagnosis of JIA
S and S >6wks
What determines the disease subtype?
by disease presentation in 1st 6mn
What are the 6 subtypes of JIA
1) Oligoarticular
- asymmetrical large jts; 4 or less jts; uveitis asym & chronic 20-30; tendonitis; boney over/under growth
- peaks 1-3 yrs female > male
2) Polyarticular
- 1-3 and 9-12; female > male; 5 jts or more; symmetrical jare ange small jts ; asym uveitis; systemic signs possible; RF+ tendon nodules involved
3) Systemic
- any age; female = male; jts variable; asympt and rare uveitis; systemic signs always positive; generlized growth retardation
4) Psoriatic
5) Enthesitis related (ESR)
- only condition where uveitis is symptomatic 10-20%
What is the key symptom of JIA that needs to be checked all the time and is usally asympt. ?
Uveitis inflame to the chambers of the eyes
WHat are 8 S and S of JIA?
1) Pain
2) decrased ROM
3) AM stiffness
4) fatigue
5) decrased function
6) asymt. posture
7) restricted muscle length and strength
8) Growth abnom.
Where does it effect?
- jt synovium
- tendon sheath synovium
- Entheses (tendon bone jt) esp feet
(** really impt to have a multidis. team with child centre focus**)
What is the goal of Rx?
decrease impact of disease so that the child can function as physically, socially and emotoinally as normal now and throughout life
- OT - more global well being soical interven (teach pain management and coping)
- PT - Body function: releive pain and stiffness; incrase joint ROM
What are the key comp. to Ax
1) Observation:
- get baseline; have they gone from walking back to crawling; ski booting; growth implications
- jt count (jt swelling OR limitaiotn of motion with heat, over presure pain or jt line tenderness)
2) Pain Ax
- P c/cout inflam - will impact childs life; need to get good understanding of pain (where/when/ how much…how often) child may not disclose infront of parents
- PAIN MANAGMENT: educ. meds, positions, modalities, jt protect (how swollen = ice; stiff = heat)
3) ROM Ax
- hypermobility will be there; take serial measurements; gonio; comp movt patterns
- 5 tests: thumbs to foreams, fingers parallel; hyperext of elbow and knees; palm to floor)
- DONt measure things that can change with growth like side flexion in standing
4) Mobility and strength
- isometric, encourage child to full effort
- common jt problems –> limited neck ext; flex PIP; TMJ NOT common
** most common knees (2-4)
- toe walking
5) Fatigue
- what patterns have changed
_** >6wks + napping = RED FLAG **_
What are the casues of fatigue ?
- active disease
- poor sleep
- uncontrolled P
- Decondition
- depression
- abnormal movt patterns
How should kids manage fatigue
* control the pain + good goals achievable
- imporve msucle strength and movt patterns
- sleep hygiene ; take bus dont walk…
- keep journals not always good b/c thenthey are focusing on it ; good ergo
What is a good Ax tool?
Gait
- tells you about functional limiations (energy, foot wear…) and restirctions (ROM/strength and muscle length)
How do you presecribe exs for JIA?
- prescribe based on acuity (acute, sub vs chronic) not all jts at the same degree at same time
- more chronic disease give more reactive, balance work
- **REMEMBER TO THINK OF TIMES WHEN CAPSULE WILL BE OVER STRETCHED - this will cause jt to be unstable**
- need to consider aherence, not too many and do they have family support are there family obligations
- attention span
- make therapy playful, adapt therapy so they dont have to adapt their life
- remind them that b/c one thing is limited one day does not mean they have to cut it out it oculd just be that day .. try it again later on
What are 2 activities that are good for JIA
Swimming and biking
What are 3 Rx adaptations and implementations?
1) serial cast
- Knees, wrist, elbows b/c of persistant fucntional loss (do it post cortico injection)
GOAL; functional ROM in new ROM & strengthen up to 3yrs post casting
2) Modify ADL’s and footwear
- educ, energy conservation, modalities (when to use heat and cold)
- larger gripped objects
- ORthotics: 3D’s is gold stnd. impt to k onw if wearing right correctly
(plastic part behind MTP NOT PAST THE JT)***
3) Adapt/inform school
- consider doc apts, fatigue, P, depression
- encourage Lesure b/c thats the first to go most times
** always want to think about childs transition –> 18yrs to mary pack or case manager, encourage good support network, like going to camps (this is very impt for physical, emotional and social support) - role models - how do they live with it?!
- get to know the specifics of what they like
NOTES:
if you had pt centered care from the beginning it should make the tranisition easier
- gain their trust and respect
What kind of disease is JIA; what do you have to consider about the growth plates?
- autoimmune disease
- depending on when it starts - the effected limb could be longer b/c the inflam process will speed up the area,
- in adolescence then effected side shorter b/c the plate closes early and fuses ( esp during puberty)
impt to consider age!!!
