Question one: What is the etiology of JIA?
Juvenile Idiopathic Arthritis (JIA) is a common type of arthritis affecting children below the age of 17. The condition relates more to malfunctioning of the immune system that targets the lining of the synovial membrane found in the joints causing an inflammation and later damages the joints. Medical professionals and disease experts are yet to establish the etiology of JIA; however, the condition is highly linked to genes transfer. JIA is not a hereditary disease because it rarely affects more than one person in the family. Multiple genes play a significant role in the onset and manifestations of JIA. IL2RA/CD25 gene is the most susceptible in causing JIA. Additionally, exposure to infections such as viral attacks makes the person develop the condition (Sherry, Rabinovich, and Poduval, 2016).
Question two: What signs and symptoms are commonly associated with systemic JIA?
Signs and symptoms of systemic JIA appear six weeks after an individual acquires arthritis. A child suffering from systemic arthritis experiences spiking fever that occurs once or twice per day and at almost the same time each day. Temperatures may drop below normal or rise above normal. Additionally, the child experiences an evanescent rash that is macular, nonpruritic, and salmon colored appearing on the trunk. Moreover, the child suffers from increased dermatologic manifestations. The individual also complains of joint pains. Other signs of systemic JIA include school absenteeism and the inability of the child to participate in physical activities (Sherry, Rabinovich, and Poduval, 2016).
Question three: How is JIA classified and what are the three main classifications of this disorder?
The International League Against Rheumatism classified JIA using three bodies, namely, the European League against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the International League of Association for Rheumatology (ILAR). These three groups develop sets of criteria for classifying JIA. JIA falls under Systemic JIA, Polyarticular JIA, RF-positive, Polyarticular JIA, RF-negative, and Oligoarticular JIA classifications. JIA also falls under the persistent (affecting 1 to 4 joints) or extended (affecting five or more joints) classifications (WebMD, 2014).
Question four: By definition, in what major way does JIA with pauciarticular (Oligoarticular) onset differ from systemic JIA?
Oligoarticular JIA refers to the subgroup of JIA that affects less than five joints in children. It constitutes approximately half of all cases of JIA (about 50 percent). Oligoarticular JIA splits into persistent oligoarthritis where the victim does not suffer any additional joint involvement after six months of diagnosis. The second division, the extended oligoarthritis, involves additional joints after six months of diagnosis. On the other hand, Systemic JIA refers to the subgroup of JIA characterized by a fever lasting for at least two weeks before the date of diagnoses. The fever must be intermittent and spike for at least three days and accompanies by either a generalized enlargement of lymph nodes, inflammation of the heart lining, liver enlargement, or characteristic rheumatoid rash. It constitutes 10 to 20 percent of all JIA cases and has equal effects on both male and female adolescents, unlike Oligoarticular JIA that is common among children. Moreover, systemic JIA affects both small and large joints (National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 2015).
Question Five: Based on her positive ANA test result, which complication is Selena at increased risk for developing?
Antinuclear antibody (ANA) occurs in some children suffering from arthritis, and its presence reveals high probability of connective tissue disease; hence, assisting the doctor to be more specific about the type of JIA. Selena's positive ANA test results revealed she suffered from Oligoarticular JIA and increased the risk of asymptomatic uveitis. Children with pauciarticular disease, which is a high-risk factor for eye disease, show positive ANA test results (Anonymous, 2010)
Question six: How does JIA differ from “growing pain,” or non-articular rheumatism?
Parents should understand how to deal with persistent morning pains in children because it may mean a more serious health problem. Selena complained of reoccurring leg pains that were more severe in the morning or after waking up from a daytime nap. Growing pains affect children between the ages of 3 and 7. The growth and development of bones and stretching the bone’s thick cover triggers the pain. However, some forms of pains experienced by the child demonstrate the presence of JIA. Pains associated with JIA differ from growing pains because the victim experiences persistent pain occurring in the morning showing swelling and redness in the joint. Additionally, the child may have difficulties walking because of pains and complain of unusual tiredness. Growing pain does not appear and go. Moreover, growing pain does not have a specific time when it appears but keeps disturbing the victim at all times; hence, differing from JIA pains (Davis, 2016).
Question seven: Considering a diagnosis of JIA with pauciarticular (Oligoarticular) onset, is Selena at risk for growth retardation? Why or why not?
Children diagnosed with JIA experience growth retardations. The risk of growth retardation depends on the JIA subtype with children suffering from Oligoarticular disease appearing at high risks for growth retardation. Selena’s diagnosis of JIA, particularly the pauciarticular JIA onset does not put her at risks of growth retardation. According to Coleman (2008), growth retardation among children diagnosed with JIA occurs because of multiple factors such as the presence of chronic diseases, malnutrition and increased energy use. Selena's medical history reveals she suffered from otitis media (OM), but doctors treated the condition, and she no longer shows any symptoms of OM. Moreover, the child has no surgical history and does not react negatively to drugs. Additionally, she shows no signs of distress, her skin color is normal, and has normal respirations. The above elements decrease Selena’s chances of experiencing growth retardations, but the doctor should recommend regular physical exercise and eat a balanced diet to help keep her strong.
Question Eight: For patients with JIA who are at risk for growth retardation, what are the primary treatment goals?
The primary treatment goals for patients with JIA who have high risks of experiencing growth retardations are to promote timely remission and minimize the duration and dosage of JIA treatment. Reducing retardation among children diagnosed with JIA occurs by controlling inflammation using available drugs and physical processes. Treatment procedures help control and improve clinical symptoms by administering specific drugs including methotrexate, biological agents, immunosuppressant, and intra-articular corticosteroids (Umławska, & Prusek-Dudkiewicz, 2010).
References
Anonymous. (2010, January 31). Early identification of juvenile idiopathic arthritis. Rheumatology
Network. Retrieved March 30, 2016, from http://www.rheumatologynetwork.com/juvenile-arthritis/early-identification-juvenile-idiopathic-arthritis
Coleman, L. A. (2008). Nutrition and rheumatic disease. Totowa, NJ: Humana Press.
Davis, J. L. (2016). Growing pains: When should parents worry? WebMD. Retrieved March 30, 2016
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2015, June). Juvenile
Arthritis. NIH. Retrieved March 30, 2016, from http://www.niams.nih.gov/Health_Info/Juv_Arthritis/
Sherry, D. D., Rabinovich, E., and Poduval, M. (2016, March 03). Juvenile Idiopathic Arthritis.
Medscape. Retrieved March 30, 2016, from http://emedicine.medscape.com/article/1007276-overview
Umławska, W., & Prusek-Dudkiewicz, A. (2010). Growth retardation and delayed puberty in
children and adolescents with juvenile idiopathic arthritis. Archives of Medical Science : AMS, 6(1), 19–23.
WebMD. (2014, January 1). Classification of Juvenile Arthritis - Topic Overview. Arthritis
Health Center. Retrieved March 30, 2016, from http://www.webmd.com/arthritis/tc/classification-of-juvenile-arthritis-topic-overview
