"JUVENILE IDIOPATHIC ARTHRITIS"

“ Defined as any idiopathic arthritis presenting at less than 16 years of age and of >6 weeks’ duration; 80% of patients present by 7 yea...

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Defined as any idiopathic arthritis presenting at less than 16 years of age and of >6 weeks’ duration; 80% of patients present by 7 years. The monoarticular variant is most common and most often affects the knee. Joint pain and stiffness along with fever, malaise, weight loss and hepatosplenomegaly are commonly demonstrated. Most are seronegative; anaemia and elevated erythrocyte sedimentation rate (ESR) may be found. Associated with a salmon-coloured rash and palpable lymph node enlargement.

US

•  More sensitive than x-ray for detecting effusions and synovitis

CHEST X-RAY

•  Pleural effusion
•  Hepatosplenomegaly

APPENDICULAR X-RAY

•  Soft tissue swelling.
•  Joint space widening (due to joint effusion and synovial hypertrophy).
•  Periarticular osteopenia (thickened synovium causes hyperaemia in the adjacent bone and radiolucency).
•  Periostitis is typical and most common in the metacarpal/metatarsal bones, where it gives the bones a more rectangular appearance.
•  Premature closure of growth plates/accelerated skeletal maturation.
•  Ankylosis and growth disturbance in chronic disease.
•  Widened intercondylar notch/squared patella (classic).
•  Other typical findings include balloon epiphyses, gracile tubular bones and ribbon ribs.
•  Unlike rheumatoid arthritis (RA), bone changes occur late and there is more ankylosis and widening of the metaphyses.

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