Rishi Desai, MD, MPH

Juvenile idiopathic arthritis

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Chapter 111 Inﬂammatory Arthritis Management and prevention ▪ Limit medications that alter urate balance (e.g. thiazides, aspirin) ▪ Initiate medications that ↓ uric acid levels ▪ Xanthine oxidase (XO) inhibitors (allopurinol, febuxostat) ▫ Mechanism of action: directly inhibits enzyme → urate production, stimulates purine base reutilization → ↓ ↓ ↓ urate concentration ▪ Uricosuric medications (probenecid) ▫ ↑ urate excretion at kidney ▪ Uricase medications (rasburicase) ▫ Mimic enzyme that catalyzes urate conversion → allantoin (more soluble purine degradation product); enzyme absent in humans  OTHER INTERVENTIONS  ▪ Beneﬁt largely due to ↓ development/ worsening of obesity, cardiovascular disease, diabetes mellitus  ▪ Diet modiﬁcation ▫ Limit/avoid soda, red meat, seafood ▪ Alcohol moderation ▪ ↑ physical activity  Figure 111.6 The histological appearance of a gouty tophus. There is a large aggregate of urate crystals which is associated with granulomatous inﬂammation.  JUVENILE IDIOPATHIC ARTHRITIS osms.it/juvenile-idiopathic-arthritis PATHOLOGY & CAUSES  SIGNS & SYMPTOMS  ▪ Arthritic symptoms of unknown etiology; present < 16 years old for ≥ six weeks ▪ Unknown pathophysiology; appears related to TH1 and TH17 cells → cell mediators ▫ IL-1, IL-17, TNF-gamma  ▪ Arthritis ▫ Oligo- or polyarticular involvement; large joints affected > small ▪ Rheumatoid nodules, factor usually absent  RISK FACTORS  ▪ HLA and PTPN22 variants  COMPLICATIONS  ▪ 10% develop disability in adulthood  DIAGNOSIS LAB RESULTS  ▪ Antinuclear antibodies may be ⊕ or ⊝  TREATMENT ▪ Similar to rheumatoid arthritis ▪ Some success with IL-6 R antibody biologic disease-modifying antirheumatic drug (DMARD)  OSMOSIS.ORG 629   

Systemic Juvenile Idiopathic Arthritis Characteristics and Presentation

Systemic Juvenile Idiopathic Arthritis Diagnosis and Management

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