Juvenile rheumatoid arthritis

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Juvenile rheumatoid arthritis"

Transcription

1 6 Juvenile rheumatoid arthritis A disease of many faces Learning Objectives to describe the number of distinct presentations, types and courses of JRA to describe the value of different kinds of laboratory testing for JRA to describe the therapies available for patients with JRA (medication, family, occupational and physical) CASE: A mother of a 2-year-old girl brings her daughter to a pediatrician for a third opinion. For the past five weeks, the girl has been feeling not quite herself in the morning. She has been irritable and slow to get out of bed, sometimes refusing to get up altogether, and walks more stiffly than usual. She gets better as the day goes on but worsens again after her afternoon nap, and seems especially uncomfortable when her diaper is being changed. Two weeks after the onset of symptoms, the mother consulted with the child s family doctor, who surmised the cause to be either normal growing pains or a bad fall on the knee. He referred the girl to an orthopedic surgeon, who failed to detect any evidence of a fall and referred the child to the pediatrician in question. EPIDEMIOLOGY AND CLINICAL PRESENTATION Juvenile arthritis (JA), encompasses the spondyloarthropathies and reactive arthritis. Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), comprises three distinct presentations, the most common of which is early-onset pauciarticular disease seen most frequently in girls, as in the above case. By definition, one of the criteria for JRA requires the exclusion of other forms of JA. Estimates for the overall prevalence of JRA in children under 16 cluster around the 0.01% mark. JRA is subdivided into three types with distinct presentations and courses: Pauciarticular JRA (pajra, four or fewer joints involved) accounts for 50% of JRA cases. 45

2 pajra patients are typically very young (one to four years) girls or older boys, although both young boys and older girls may be affected. Chronic uveitis involving the anterior chamber of the eye, a fairly frequent manifestation of pajra, may cause permanent damage to the eye but more commonly produces only minimal symptoms. Uveitis eventually affects up to 20% of children with pajra, and is usually asymptomatic. Polyarticular onset JRA (pojra, five or more joints involved) occurs in 40% of the JRA population. Clinical manifestations include irritability, fatigue, anorexia, anemia and growth retardation along with joint symptoms. pojra may develop at any age and affects girls more often than boys, particularly the subtype with later onset and rheumatoid factor (RF) positivity. Systemic onset JRA (sjra) accounts for about 10% of cases and is initially characterized by daily or twice-daily fever spikes and a characteristic pale pink rash, most commonly on the trunk and proximal extremities. Fever, which may be subnormal in the morning, must be present for a minimum of two weeks. In addition to the rash and fever, children often have other visceral disease, including hepatosplenomegaly, lymphadenopathy, plevitis and pericarditis. sjra affects boys and girls equally and may strike at any time, though the peak age of onset is one to six years. There is no increased frequency of occurrence at any age. The most telling clinical symptom of JRA (as reported by either children or parents) is morning stiffness and hesitancy of movement in the affected areas. A recent history of fever spikes and rash on the torso raise the spectre of sjra, while fatigue and poor appetite suggest pojra. Constitutional symptoms such as fatigue, poor appetite and weight loss suggest sjra and pojra. A physical examination often reveals swelling (but not redness) in the affected joints. DIFFERENTIAL DIAGNOSIS The above case represents a fairly common sequence of doctor visits. Because joint injuries (falls, sprains, etc.) are especially common in children, family doctors are often inclined to attribute joint discomfort to an injury rather than to JRA, which is much rarer. In this regard, it is helpful to remember that 46

3 joint pain alone (i.e. in the absence of any swelling, stiffness, tenderness, etc.) is never sufficient to establish a diagnosis of JRA. To rule out arthropathy caused by a viral infection, a JRA diagnosis also requires that symptoms be present for at least six consecutive weeks. Other forms of juvenile arthritis must be excluded, including arthritis associated with IBD, psoriasis, ankylosing spondylitis and reactive arthritis, along with other connective tissue diseases such as dermatomyositis. Other conditions that can initially present in the bones and joints, as well as cause fever and general malaise, include septic arthritis, osteomyelitis, IBD, other connective tissue diseases, leukemia and neuroblastoma. However, a child with septic arthri- JRA DIAGNOSIS AT A GLANCE Symptoms: Morning stiffness, restricted or awkward movements, pain on motion, tenderness Physical findings: Swelling, joint warmth Laboratory findings: Rheumatoid factor, ANA positivity, erosions, joint space narrowing Radiograph changes: Soft tissue swelling, erosions, localized growth disturbances, with advanced maturation of epiphyseal ossification centres Differentiate from: Sprains, strains, fractures, growing pains, viral infection, septic arthritis, osteomyelitis, leukemia, neuroblastoma, etc. Fig. 2: Juvenile rheumatoid arthritis 47

4 tis usually has joint redness as well as severe limitation of movement; osteomyelitis reveals itself through a characteristic bony tenderness; in the case of leukemia, careful physical examination would reveal enlargements in the liver, spleen, and/or lymph nodes (also characteristic findings of systemic JRA); and neuroblastoma involves generalized pain and possibly an abdominal mass. In some cases, what appears to be a simple case of JRA turns out to be fibromyalgia (or coexisting JRA and fibromyalgia). This possibility should be considered in older children if treatment does not produce improvement within the expected range. It may also be very difficult to distinguish systemic JRA from leukemia; in these cases, a bone marrow aspirate is indicated. LABORATORY TESTING JRA is a diagnosis of exclusion, meaning there are no tests that can specifically rule it in. That said, the antinuclear antibody (ANA) test can be of value when clinical findings strongly suggest JRA, as the test is positive in 60% to 80% of JRA patients, particularly those with pauciarticular disease. ANAs have a high prevalence (65% to 85%) in children with paucijra and chronic uveitis. Therefore, it is an important test for identifying which children are at increased risk for developing chronic anterior uveitis. On the other hand, the RF test, often used to corroborate a diagnosis of adult RA, is positive in only 15% to 20% of children with JRA. It is more frequently seen in children with later onset polyarthritis, and is associated with a more aggressive disease course. WHEN TO REFER JRA diagnosis is uncertain and needs to be established or confirmed JRA diagnosis is established; in all such cases, patients need to be under the care of a rheumatologist (ideally one with a subspecialty in pediatric rheumatology) EXPECTED COURSE & MANAGEMENT Between 40% and 50% of JRA patients have disease that persists into adulthood, and more than 30% have significant functional limitations after 10 or more years of follow-up. The outcome for JRAassociated uveitis has improved significantly over the past few 48

5 decades, and the majority of JRA patients with uveitis are able to maintain their visual acuity over time. Although prognosis for sight is improving, it is estimated blindness occurs in as many as 15% to 30% of cases. Therefore, immediate referral to an ophthalmologist at disease onset particularly if the patient is ANA-positive is critical, as is annual follow-up. The therapeutic goals for JRA patients include relieving symptoms, maintaining joint motion and muscle strength, minimizing joint damage and promoting a positive self-image. Rehabilitation plays a key role with JRA patients. Regular monitoring is important to detect flares and impairments that can lead to disability. Exercise and splinting help to maintain and improve function. Therapist involvement in the classroom can DIAGNOSTIC & TREATMENT SUMMARY Criteria for systemic JRA: Persistent arthritis in one or more joints for at least six weeks Exclusion of other forms of arthritis Persistent (minimum of two weeks) intermittent fever (daily temperature peaks of 101 or higher) Stills rash (variable) Criteria for pauciarticular JRA: Persistent arthritis in one to four joints for at least six weeks Arthritis in no more than four joints during the first six months of disease Exclusion of other forms of arthritis including systemic JRA Uveitis (variable) 20% of patients Criteria for polyarticular JRA: Persistent arthritis in one or more joints for at least six weeks Arthritis in five or more joints over the first six months of disease Exclusion of other forms of arthritis including systemic JRA Uveitis (uncommon) 5% of patients Treatment: Physical and occupational therapy Assistance with psychosocial adjustments (for patient and family) In milder cases: NSAIDs In more severe cases: methotrexate and/or other DMARD as well as NSAIDs Oral or injected steroids as needed (in restricted cases) 49

6 facilitate function and accommodation. Parents and families often benefit from psychosocial support. Pharmacological management of JRA encompasses treatment of the articular, ocular, and other manifestations of the disease. In patients with milder disease, the articular manifestations can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with the caveat that the dose required for an anti-inflammatory effect is up to twice the dose needed for pain control. Children are often inadequately treated with NSAIDs alone, and require therapy with methotrexate and/or diseasemodifying anti-rheumatic drugs (DMARDs). Almost half of children with JRA require DMARDs. In cases of severe polyarticular JRA, oral steroids are sometimes used while waiting for DMARD therapy to take effect. In systemic JRA, oral steroids are often used for control of systemic features. In all three types of JRA, intra-articular corticosteroids can be used. The role of the new biological agents continues to be determined. Treatment of uveitis should be directed by an experienced ophthalmologist. Early detection, topical corticosteroids, dilating agents and frequent follow-up are critical and effective in the majority of cases. QUESTIONS 1. In what respects does juvenile rheumatoid arthritis differ from adult rheumatoid arthritis? JRA correlates much more poorly with a positive RF test than does adult RA. Several clinical manifestations of JRA, such as uveitis (mostly with pajra) and pale pink rash (with sjra), are not seen in adult JRA. 2. What aspects of a young patient s history are most suggestive of JRA? Persistent arthritis in affected joints, pain on motion, limitation of motion, tenderness, joint warmth, stiff or awkward movements (often noted by caregivers), and difficulty or reluctance to get out of bed. 50

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis Juvenile Rheumatoid Arthritis (JRA; Juvenile Chronic Polyarthritis; Still s Disease) Pronounced: jew-va-nigh-el roo-mah-toyd arth-ri-tis by Jacquelyn Rudis En Español (Spanish Version) Definition Juvenile

More information

Arthritis in Children: Juvenile Rheumatoid Arthritis By Kerry V. Cooke

Arthritis in Children: Juvenile Rheumatoid Arthritis By Kerry V. Cooke Reading Comprehension Read the following essay on juvenile rheumatoid arthritis. Then use the information in the text to answer the questions that follow. Arthritis in Children: Juvenile Rheumatoid Arthritis

More information

QUESTIONS AND ANSWERS ABOUT JUVENILE RHEUMATOID ARTHRITIS

QUESTIONS AND ANSWERS ABOUT JUVENILE RHEUMATOID ARTHRITIS QUESTIONS AND ANSWERS ABOUT JUVENILE RHEUMATOID ARTHRITIS What Is Arthritis? Arthritis means joint inflammation, and refers to a group of diseases that cause pain, swelling, stiffness and loss of motion

More information

Critical Issues in School Health Arthritis in the School Setting. Lawrence Zemel MD Tegan Willard RN Connecticut Children s

Critical Issues in School Health Arthritis in the School Setting. Lawrence Zemel MD Tegan Willard RN Connecticut Children s Critical Issues in School Health Arthritis in the School Setting Lawrence Zemel MD Tegan Willard RN Connecticut Children s Juvenile Rheumatoid Idiopathic Arthritis Definition of JRA (JIA) Persistent arthritis

More information

Rheumatoid Arthritis www.arthritis.org.nz

Rheumatoid Arthritis www.arthritis.org.nz Rheumatoid Arthritis www.arthritis.org.nz Did you know? RA is the second most common form of arthritis Approximately 40,000 New Zealanders have RA RA can occur at any age, but most often appears between

More information

Understanding Rheumatoid Arthritis

Understanding Rheumatoid Arthritis Understanding Rheumatoid Arthritis Understanding Rheumatoid Arthritis What Is Rheumatoid Arthritis? 1,2 Rheumatoid arthritis (RA) is a chronic autoimmune disease. It causes joints to swell and can result

More information

(Intro to Arthritis with a. Arthritis) Manager of Education & Services for the Vancouver Island Region of The Arthritis Society

(Intro to Arthritis with a. Arthritis) Manager of Education & Services for the Vancouver Island Region of The Arthritis Society Arthritis 101 (Intro to Arthritis with a Focus on Rheumatoid Arthritis) by Cari Taylor by Cari Taylor Manager of Education & Services for the Vancouver Island Region of The Arthritis Society What You Will

More information

TAKING CARE OF YOUR RHEUMATOID ARTHRITIS

TAKING CARE OF YOUR RHEUMATOID ARTHRITIS TAKING CARE OF YOUR RHEUMATOID ARTHRITIS RHEUMATOID ARTHRITIS (RA) FAST FACTS What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is a chronic disease that can affect your ability to function and be

More information

Rheumatoid Arthritis

Rheumatoid Arthritis Rheumatoid Arthritis While rheumatoid arthritis (RA) has long been feared as one of the most disabling types of arthritis, the outlook has dramatically improved for many newly diagnosed patients. Certainly

More information

Juvenile idiopathic arthritis and its long term outcome

Juvenile idiopathic arthritis and its long term outcome Focus Juvenile idiopathic arthritis and its long term outcome Sue Rudge is a paediatric rheumatologist at the Wellington Regional Rheumatology Unit and Starship Hospital, Auckland Introduction KEY POINTS

More information

Blau's Disease / Juvenile Sarcoidosis

Blau's Disease / Juvenile Sarcoidosis www.printo.it/pediatric-rheumatology/ie/intro Blau's Disease / Juvenile Sarcoidosis Version of 2016 1. WHAT IS BLAU S DISEASE/JUVENILE SARCOIDOSIS 1.1 What is it? Blau syndrome is a genetic disease. Patients

More information

Finding out your child has Juvenile Idiopathic Arthritis (JIA)

Finding out your child has Juvenile Idiopathic Arthritis (JIA) Finding out your child has Juvenile Idiopathic Arthritis (JIA) Information for parents, families and carers Jetstar Flying Start Ambassador Steve Price with Tamsin Taylor and Jennifer McNaughton Did you

More information

Rheumatoid Arthritis. Nicole Klett,, M.D.

Rheumatoid Arthritis. Nicole Klett,, M.D. Rheumatoid Arthritis Nicole Klett,, M.D. Rheumatoid Arthritis Systemic Chronic Inflammatory Primarily targets the synovium of diarthrodial joints Etiology likely combination genetic and environmental Diarthrodial

More information

A Patient s Guide to Psoriatic Arthritis. Foot and Ankle Center of Massachusetts, P.C.

A Patient s Guide to Psoriatic Arthritis. Foot and Ankle Center of Massachusetts, P.C. A Patient s Guide to Psoriatic Arthritis Welcome to Foot and Ankle Center of Massachusetts, where we believe in accelerating your learning curve with educational materials that are clearly written and

More information

Recognise, Respond, Relieve, Rheumatoid Arthritis

Recognise, Respond, Relieve, Rheumatoid Arthritis Recognise, Respond, Relieve, Rheumatoid Arthritis Anybody can develop rheumatoid arthritis. It can develop at any age in adults but is more common in people in their 40s and 50s. It is two to three times

More information

Rheumatoid Arthritis: Diagnosis, Management and Monitoring

Rheumatoid Arthritis: Diagnosis, Management and Monitoring Rheumatoid Arthritis: Diagnosis, Management and Monitoring Effective Date: September 30, 2012 Scope This guideline is intended to aid in early recognition, intervention and management of patients with

More information

Ankylosing Spondylitis

Ankylosing Spondylitis Ankylosing Spondylitis Disease AS 150610 Final.indd 2 15. 6. 10. 12:16 Understanding what to expect can help you prepare for your transition into treatment. Ankylosing Spondylitis What You Need To Know

More information

Temple Physical Therapy

Temple Physical Therapy Temple Physical Therapy A General Overview of Common Neck Injuries For current information on Temple Physical Therapy related news and for a healthy and safe return to work, sport and recreation Like Us

More information

Rheumatoid Arthritis www.arthritis.org.nz

Rheumatoid Arthritis www.arthritis.org.nz Rheumatoid Arthritis www.arthritis.org.nz Did you know? Rheumatoid arthritis (RA) is the third most common form of arthritis Approximately 40,000 New Zealanders have RA RA can occur at any age, but most

More information

Psoriatic Arthritis. What is psoriatic arthritis? Understanding joints. Who gets psoriatic arthritis? Page 1 of 5

Psoriatic Arthritis. What is psoriatic arthritis? Understanding joints. Who gets psoriatic arthritis? Page 1 of 5 Page 1 of 5 Psoriatic Arthritis Psoriatic arthritis causes inflammation, pain, and swelling of joints in some people who have psoriasis. Other parts of the body may also be affected. For example, in many

More information

DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES

DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES GOAL #1 develop the ability to order and understand interpretation

More information

Psoriatic Arthritis. eorthopod.com 228 West Main St., Suite D Missoula, MT Phone: Fax:

Psoriatic Arthritis. eorthopod.com 228 West Main St., Suite D Missoula, MT Phone: Fax: A Patient s Guide to Psoriatic Arthritis 228 West Main St., Suite D Missoula, MT 59802-4345 Phone: 406-721-3072 Fax: 406-721-2619 info@eorthopod.com DISCLAIMER: The information in this booklet is compiled

More information

Juvenile Arthritis: A Teacher s Guide

Juvenile Arthritis: A Teacher s Guide arthritis.org Juvenile Arthritis: A Teacher s Guide How you can help your student succeed Understanding Juvenile Arthritis If you re surprised that arthritis affects children, you re not alone. Most people

More information

Rheumatoid Arthritis

Rheumatoid Arthritis What is Rheumatoid Arthritis? Rheumatoid Arthritis (RA) is a chronic and systemic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints

More information

Information on Rheumatoid Arthritis

Information on Rheumatoid Arthritis Information on Rheumatoid Arthritis Table of Contents About Rheumatoid Arthritis 1 Definition 1 Signs and symptoms 1 Causes 1 Risk factors 1 Test and diagnosis 2 Treatment options 2 Lifestyle 3 References

More information

Page 1 of 15 Origination Date: 09/14 Revision Date(s): 10/2015, 02/2016 Developed By: Medical Criteria Committee 10/28/2015

Page 1 of 15 Origination Date: 09/14 Revision Date(s): 10/2015, 02/2016 Developed By: Medical Criteria Committee 10/28/2015 Moda Health Plan, Inc. Medical Necessity Criteria Subject: Actemra (tocilizumab) Page 1 of 15 Origination Date: 09/14 Revision Date(s): 10/2015, 02/2016 Developed By: Medical Criteria Committee 10/28/2015

More information

Rheumatoid Arthritis

Rheumatoid Arthritis Rheumatoid Arthritis Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly

More information

Rheumatoid Arthritis: Symptoms, Causes, and Treatments of Rheumatoid Foot and Ankle

Rheumatoid Arthritis: Symptoms, Causes, and Treatments of Rheumatoid Foot and Ankle Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Rheumatoid arthritis is a symmetric disease, meaning that it will usually involve

More information

Rheumatoid Arthritis. GP workshop 15 January 2011

Rheumatoid Arthritis. GP workshop 15 January 2011 Rheumatoid Arthritis GP workshop 15 January 2011 Case 1 A 72 year old Malay woman with RA comes for routine follow up. She feels generally unwell in the last 5 days. Appetite is fair. Her joints are fine.

More information

Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation.

Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation. HealthExchange Points For Your Joints An Arthritis Talk Howard Epstein, MD Orthopaedic & Rheumatologic Institute Rheumatic & Immunologic Disease Cleveland Clinic Beachwood Family Health & Surgery Center

More information

Biologic Treatments for Rheumatoid Arthritis

Biologic Treatments for Rheumatoid Arthritis Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been

More information

Rheumatology. Rheumatoid Arthritis

Rheumatology. Rheumatoid Arthritis Rheumatology Rheumatoid Arthritis The Rheumatology service specialises in the diagnosis and treatment of diseases affecting the musculoskeletal system. Other than providing inpatient and outpatient consultation,

More information

Rheumatoid Arthritis. Disease RA Final.indd 2 15. 6. 10. 11:23

Rheumatoid Arthritis. Disease RA Final.indd 2 15. 6. 10. 11:23 Rheumatoid Arthritis Disease RA Final.indd 2 15. 6. 10. 11:23 Understanding what to expect can help you prepare for your transition into treatment. Rheumatoid Arthritis What You Need To Know About Rheumatoid

More information

Sarcoidosis. Exceptional healthcare, personally delivered

Sarcoidosis. Exceptional healthcare, personally delivered Sarcoidosis Exceptional healthcare, personally delivered The Bristol Interstitial Lung Disease Service at North Bristol NHS Trust cares for a catchment area of around 550,000 people (plus additional referrals

More information

Dr Sarah Levy Consultant Rheumatology Croydon University Hospital

Dr Sarah Levy Consultant Rheumatology Croydon University Hospital Dr Sarah Levy Consultant Rheumatology Croydon University Hospital Contents Definition/ epidemiology Diagnosis Importance of early diagnosis/ treatment Guidelines Evidence based treatment protocol Current

More information

Understanding Ankylosing Spondylitis

Understanding Ankylosing Spondylitis Understanding Ankylosing Spondylitis SIM0197_Understanding_AnkylosingSpondylitis_V3FA.indd 1 Contents Introduction 3 What is ankylosing spondylitis? 4 Symptoms of ankylosing spondylitis 5 What causes ankylosing

More information

a. "He'll (She'll) out grow it." b. "The drops will get him (her) through it." c. "It's just the eye; systemic therapy is not warranted.

a. He'll (She'll) out grow it. b. The drops will get him (her) through it. c. It's just the eye; systemic therapy is not warranted. Pediatric Uveitis C. Stephen Foster, M.D. Uveitis is the third leading cause of blindness in America, and 5% to 10% of the cases occur in children under the age of 16. But Uveitis in children blinds a

More information

What is Psoriatic Arthritis?

What is Psoriatic Arthritis? What is Psoriatic Arthritis? A positive approach to psoriasis and psoriatic arthritis What is psoriasis? Psoriasis (sor-i ah-sis) is a long-term (chronic) scaling disease of the skin, which affects 2%-3%

More information

Symptoms ongoing for 6/12, initially intermittent in nature.

Symptoms ongoing for 6/12, initially intermittent in nature. Rheumatoid Arthritis Case Study INTRODUCTION Each student will have watched the relevant MDT member carrying out their initial assessment on the same newly diagnosed Rheumatoid Arthritis patient. Videos

More information

Infl ectra for rheumatoid arthritis

Infl ectra for rheumatoid arthritis Infl ectra for rheumatoid arthritis Some important information to get you started with your treatment This booklet is intended only for use by patients who have been prescribed Inflectra. Introduction

More information

PSORIATIC ARTHRITIS. Chryssanthie Kafkala, M.D. INTRODUCTION:

PSORIATIC ARTHRITIS. Chryssanthie Kafkala, M.D. INTRODUCTION: PSORIATIC ARTHRITIS Chryssanthie Kafkala, M.D. INTRODUCTION: Psoriatic arthritis is a disease with generally good prognosis. Both ocular and systemic involvement is usually benign, however, the following

More information

The word rheumatism is derived from the Greek word "rheuma," which means a swelling.

The word rheumatism is derived from the Greek word rheuma, which means a swelling. How to manage Pain & Rheumatism The word rheumatism is derived from the Greek word "rheuma," which means a swelling. It refers to an acute or chronic illness, which is characterised by pain and swelling

More information

Arthritis of the Shoulder

Arthritis of the Shoulder Arthritis of the Shoulder In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey.

More information

Facts About Aging and Bone Health

Facts About Aging and Bone Health Facts About Aging and Bone Health A Guide to Better Understanding and Well Being with the compliments of Division of Health Services Diocese of Camden Exercise as treatment Along with medication, proper

More information

Polymyalgia Rheumatica

Polymyalgia Rheumatica Polymyalgia Rheumatica WHAT IS POLYMYALGIA RHEUMATICA? Polymyalgia rheumatica (PAH-lee-my-ALjah roo-ma-tih-kah), or PMR, is a form of arthritis that causes pain and stiffness in the neck, shoulder and

More information

When you need extra help with your rheumatoid arthritis symptoms

When you need extra help with your rheumatoid arthritis symptoms When you need extra help with your rheumatoid arthritis symptoms Ask about adding Acthar. What is Acthar? Acthar is a prescription medicine to be used as a short-term add-on therapy in the event of symptoms

More information

Rheumatoid Arthritis Information

Rheumatoid Arthritis Information Rheumatoid Arthritis Information Definition Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs. Alternative

More information

ABOUT RHEUMATOID ARTHRITIS

ABOUT RHEUMATOID ARTHRITIS MEDIA BACKGROUNDER ABOUT RHEUMATOID ARTHRITIS Rheumatoid arthritis (RA) is a type of arthritis (chronic inflammatory polyarthritis) that typically affects hands and feet, although any joint in the body

More information

RHEUMATOLOGY ICD-10 CROSSWALK

RHEUMATOLOGY ICD-10 CROSSWALK RHEUMATOLOGY ICD-10 CROSSWALK ICD is revised periodically and is currently in its tenth edition and will be implemented in the United States on October 1, 2015. There is an annual minor update and three-yearly

More information

Arthritis and Rheumatology Clinics of Kansas Patient Education. Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis

Arthritis and Rheumatology Clinics of Kansas Patient Education. Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis Arthritis and Rheumatology Clinics of Kansas Patient Education Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis Introduction: For as long as scientists have studied rheumatic disease,

More information

Rheumatoid Arthritis. Outline. Treatment Goal 4/10/2013. Clinical evaluation New treatment options Future research Discussion

Rheumatoid Arthritis. Outline. Treatment Goal 4/10/2013. Clinical evaluation New treatment options Future research Discussion Rheumatoid Arthritis Robert L. Talbert, Pharm.D., FCCP, BCPS University of Texas at Austin College of Pharmacy University of Texas Health Science Center at San Antonio Outline Clinical evaluation New treatment

More information

Arthritis www.patientedu.org

Arthritis www.patientedu.org written by Harvard Medical School Arthritis www.patientedu.org Arthritis is the most common chronic disease in the world, and it s the leading cause of disability in the United States. There are more than

More information

Shoulder Osteoarthritis Tim Coughlin

Shoulder Osteoarthritis Tim Coughlin Shoulder Osteoarthritis Tim Coughlin The glenohumeral joint can cause significant morbidity when it starts to become arthritic. More than any other joint in the body it relies on a significant range of

More information

Arthritis in Children

Arthritis in Children Arthritis in Children WHAT IS JUVENILE ARTHRITIS? The word arthritis literally means joint inflammation (arth=joint; itis=inflammation). Joint inflammation causes joint pain, stiffness, swelling and decreased

More information

Polymyalgia Rheumatica and Giant Cell Arteritis. Questions Answers & about...

Polymyalgia Rheumatica and Giant Cell Arteritis. Questions Answers & about... Questions Answers & about... Polymyalgia Rheumatica and Giant Cell Arteritis National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Institutes of Health Public Health Service

More information

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome Page 1 of 5 Carpal Tunnel Syndrome Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. Anatomy The carpal tunnel is a narrow, tunnel-like structure

More information

Adalimumab Drug information. Adalimumab is used for several types of inflammatory arthritis.

Adalimumab Drug information. Adalimumab is used for several types of inflammatory arthritis. Adalimumab Drug information Adalimumab is used for several types of inflammatory arthritis. Adalimumab should effectively treat your condition, and stop it causing damage to your joints. It has been tested

More information

Copyright Bradley Whale 2011. No unauthorised reproductions.

Copyright Bradley Whale 2011. No unauthorised reproductions. Knee Anatomy While there are four bones that come together at the knee, only the femur (thigh bone) and the tibia (shin bone) form the joint itself. The head of the fibula (strut bone on the outside of

More information

ARTHRITIS IN CHILDREN

ARTHRITIS IN CHILDREN ARTHRITIS FOUNDATION Registered Nonprofit Organisation - No. 002-847 NPO Helpline No: 0861 30 30 30 ARTHRITIS IN CHILDREN This information leaflet is published by the Arthritis Foundation as part of our

More information

LUPUS. The Joints and Muscles LUPUSUK 2015

LUPUS. The Joints and Muscles LUPUSUK 2015 4 LUPUS The Joints and Muscles LUPUSUK 2015 LUPUS The Joints and Muscles Joint and muscle pain is one of the most common symptoms of lupus and most people will experience some such problems during their

More information

RHEUMATOID ARTHRITIS ASSOCIATED SCLERITIS

RHEUMATOID ARTHRITIS ASSOCIATED SCLERITIS RHEUMATOID ARTHRITIS ASSOCIATED SCLERITIS FEHMA TUFAIL M.D Case Report A 77-year-old white male presented with a history of painful, red right eye. The patient was diagnosed with mild iritis in the right

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES `I. Requirements for Prior Authorization of Cytokine and CAM Antagonists

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES `I. Requirements for Prior Authorization of Cytokine and CAM Antagonists MEDICAL ASSISTANCE HBOOK `I. Requirements for Prior Authorization of Cytokine and CAM Antagonists A. Prescriptions That Require Prior Authorization All prescriptions for Cytokine and CAM Antagonists must

More information

Autoimmune Diseases More common than you think Randall Stevens, MD

Autoimmune Diseases More common than you think Randall Stevens, MD Autoimmune Diseases More common than you think Randall Stevens, MD picture placeholder Autoimmune Diseases More than 60 different disorders Autoimmune disorders (AID) diseases caused by the immune system

More information

Drug Therapy Guidelines: Humira (adalimumab)

Drug Therapy Guidelines: Humira (adalimumab) Drug Therapy Guidelines: Humira (adalimumab) Effective Date: 5/1/08 Committee Review Date: 1/6/01, 9/18/01, 1/15/02, 1/7/03, 1/20/04, 1/18/05, 12/7/05, 10/15/06, 7/2/07, 11/5/07, 3/25/08 Policy Statements:

More information

Cervical Spondylosis (Arthritis of the Neck)

Cervical Spondylosis (Arthritis of the Neck) Copyright 2009 American Academy of Orthopaedic Surgeons Cervical Spondylosis (Arthritis of the Neck) Neck pain is extremely common. It can be caused by many things, and is most often related to getting

More information

Herniated Cervical Disc

Herniated Cervical Disc Herniated Cervical Disc North American Spine Society Public Education Series What Is a Herniated Disc? The backbone, or spine, is composed of a series of connected bones called vertebrae. The vertebrae

More information

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis LYMPHOMA IN DOGS Lymphoma is a relatively common cancer in dogs. It is a cancer of lymphocytes (a type of white blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in the

More information

Lupus in Children and Teenagers. Arielle Hay, MD Pediatric Rheumatologist Nicklaus Children s Hospital

Lupus in Children and Teenagers. Arielle Hay, MD Pediatric Rheumatologist Nicklaus Children s Hospital Lupus in Children and Teenagers Arielle Hay, MD Pediatric Rheumatologist Nicklaus Children s Hospital Systemic Lupus Erythematosus (SLE) Chronic Illness What is lupus? Autoimmune Multisystem Antinuclear

More information

Osteoporosis and Arthritis: Two Common but Different Conditions

Osteoporosis and Arthritis: Two Common but Different Conditions and : Two Common but Different Conditions National Institutes of Health and Related Bone Diseases ~ National Resource Center 2 AMS Circle Bethesda, MD 20892 3676 Tel: 800 624 BONE or 202 223 0344 Fax:

More information

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal Anti-Inflammatory Drugs (NSAIDs) Non-steroidal Anti-Inflammatory Drugs (NSAIDs) About your medicine NSAIDs are pain medications used to relieve your pain and inflammation (e.g. swelling, redness and warmth). NSAIDs may be prescribed with

More information

RHEUMATOID ARTHRITIS. Dr Bruce Kirkham Rheumatology Clinical Lead

RHEUMATOID ARTHRITIS. Dr Bruce Kirkham Rheumatology Clinical Lead RHEUMATOID ARTHRITIS Dr Bruce Kirkham Rheumatology Clinical Lead RHEUMATOID ARTHRITIS (RA) RA is a common disease: 0.8 per cent of the population RA more common in females: female to male ratio 3:1 RA

More information

First Name. Specialty: Fax. First Name DOB: Duration:

First Name. Specialty: Fax. First Name DOB: Duration: Prescriber Information Last ame: First ame DEA/PI: Specialty: Phone - - Fax - - Member Information Last ame: First ame Member ID umber DOB: - - Medication Information: Drug ame and Strength: Diagnosis:

More information

Psoriatic Arthritis www.arthritis.org.nz

Psoriatic Arthritis www.arthritis.org.nz Psoriatic Arthritis www.arthritis.org.nz Did you know? Arthritis affects one in six New Zealanders over the age of 15 years. Psoriatic arthritis usually appears in people between the ages of 30 to 50.

More information

Rheumatoid Arthritis

Rheumatoid Arthritis Rheumatoid Arthritis WHAT IS RHEUMATOID ARTHRITIS? Rheumatoid arthritis, or RA, is a common form of arthritis (arth means joint, itis means inflammation). RA causes inflammation in the lining of joints,

More information

Rheumatology ICD-10 documentation

Rheumatology ICD-10 documentation Rheumatology documentation Seven key impacts to documentation 1. Disease or disorder site 2. Acuity and/or encounter status of treatment 3. Etiology, causative agent, or disease type and injury/ poisoning

More information

APPLICATION FOR SUBSIDY BY SPECIAL AUTHORITY

APPLICATION FOR SUBSIDY BY SPECIAL AUTHORITY APPLICANT (stamp sticker acceptable) Page 1 Fm SA1478 Etanercept INITIAL APPLICATION - juvenile idiopathic arthritis Applications only from a named specialist rheumatologist. Approvals valid f 4 months.

More information

The Complete Guide to Upper Extremity Surgery and Injury Recovery

The Complete Guide to Upper Extremity Surgery and Injury Recovery The Complete Guide to Upper Extremity Surgery and Injury Recovery INTRODUCTION... 1 COMMON UPPER EXTREMITY INJURIES... 1 HAND OR WRIST FRACTURE... 2 HAND OR WRIST SPRAINS... 3 CHRONIC PAIN... 3 REOCCURING

More information

Ankylosing Spondylitis

Ankylosing Spondylitis Ankylosing Spondylitis What is ankylosing spondylitis? Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back

More information

Psoriatic Arthritis. Title. Understanding and Managing. in All the Wrong Places. Clinical Features. Etiology of Psoriatic Arthritis

Psoriatic Arthritis. Title. Understanding and Managing. in All the Wrong Places. Clinical Features. Etiology of Psoriatic Arthritis Focus on CME at Memorial University Understanding and Managing Title Psoriatic Arthritis in All the Wrong Places Proton Rahman MD, MSc, FRCPC Although Baron Jean-Luis Aubert offered the first case description

More information

Osteoarthritis of the Wrist Joint

Osteoarthritis of the Wrist Joint A Patient s Guide to Osteoarthritis of the Wrist Joint 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is compiled

More information

arthritis 1 arthritisconnect.com

arthritis 1 arthritisconnect.com arthritis What is Arthritis? There are more than 100 forms of arthritis currently identified. The common thread among these 100-plus conditions is that they all affect the musculoskeletal system and specifically

More information

Psoriatic arthritis FACTSHEET

Psoriatic arthritis FACTSHEET 1 What is psoriatic arthritis? Psoriatic arthritis (PsA) is a disease where joints around the body become inflamed and sore. It can make moving about difficult and painful. People who have PsA also have

More information

ARTHRITIS- Current Medical and Surgical Management

ARTHRITIS- Current Medical and Surgical Management ARTHRITIS- Current Medical and Surgical Management Dr Jacqueline Andrews Consultant Rheumatologist Mr George Whitwell and Mr Campbell Maceachern Consultant Orthopaedic Surgeons Leeds Teaching Hospitals

More information

Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system.

Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints

More information

Causes and treatment of joint pain

Causes and treatment of joint pain Causes and treatment of joint pain Aims Major rheumatic conditions 1. Autoimmune 2. crystal-related 3. degenerative Origins of joint pain - inflammatory or damage-related Therapeutic options 1. Analgesia

More information

RHEUMATOID ARTHRITIS. Semmelweis University 3rd Department of Medicine. György Temesszentandrási MD

RHEUMATOID ARTHRITIS. Semmelweis University 3rd Department of Medicine. György Temesszentandrási MD RHEUMATOID ARTHRITIS Semmelweis University 3rd Department of Medicine György Temesszentandrási MD Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease predominantly affecting diarthrodial

More information

Do I need a physician referral? Yes, we see patients on referral from a health care provider.

Do I need a physician referral? Yes, we see patients on referral from a health care provider. FAQS FOR OFFICE POLICIES How do I get an appointment? New appointments are made by physician referral only. Your referring health care provided will call for the appointment for you. What do I need to

More information

Corporate Medical Policy Steroid Injections to the Knee and/or Shoulder Notification. Policy Effective TBD

Corporate Medical Policy Steroid Injections to the Knee and/or Shoulder Notification. Policy Effective TBD Corporate Medical Policy Steroid Injections to the Knee and/or Shoulder Notification File Name: Origination: Last CAP Review: Next CAP Review: Last Review: Steroid_injections_to_the_knee_and_shoulder 05/2016

More information

PAR Joint Health. Inflammation and Joint

PAR Joint Health. Inflammation and Joint PAR ARACTIN Joint Health Inflammation and Joint Arthritis affects more than 7 million Americans. Arthritis is a disease that results in inflammation, pain and stiffness, primarily in the joints and connective

More information

Sample Treatment Protocol

Sample Treatment Protocol Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting

More information

T M J D I S O R D E R S. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

T M J D I S O R D E R S. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health T M J D I S O R D E R S U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health CONTENTS 2 4 6 7 8 9 13 14 16 WHAT IS THE TEMPOROMANDIBULAR JOINT? WHAT ARE TMJ DISORDERS? WHAT CAUSES

More information

Stickler Syndrome and Arthritis

Stickler Syndrome and Arthritis Stickler Syndrome and Arthritis Arthritis Foundation Pacific Region, Nevada Office Presented by: Crystal Schulz, MPH Community Development Manager Arthritis Foundation Improving lives through leadership

More information

Get Rid of Elbow Pain

Get Rid of Elbow Pain Get Rid of Elbow Pain Self Regional Healthcare Optimum Life Center 115 Academy Avenue Greenwood, SC 29646 Office: (864) 725-7088 Self Regional Healthcare Physical Therapy Savannah Lakes 207 Holiday Road

More information

The ANA Test: All You Need to Know Department of Family and Community Medicine Family Medicine Update April 25, 2014

The ANA Test: All You Need to Know Department of Family and Community Medicine Family Medicine Update April 25, 2014 The ANA Test: All You Need to Know Department of Family and Community Medicine Family Medicine Update April 25, 2014 Celso R. Velázquez MD Division of Rheumatology University of Missouri velazquezc@health.missouri.edu

More information

Suffering with osteoarthritis knee pain? Take control of your OA knee pain SYNVISC and Synvisc-One can help

Suffering with osteoarthritis knee pain? Take control of your OA knee pain SYNVISC and Synvisc-One can help Take control of your OA knee pain SYNVISC and Synvisc-One can help SYNVISC provides up to 12 months sustained pain relief Synvisc-One provides up to 6 months of pain relief with just 1 injection More than

More information

Ankylosing Spondylitis

Ankylosing Spondylitis Ankylosing Spondylitis www.arthritis.org.nz Did you know? Arthritis affects one in six New Zealanders over the age of 15 years AS is a type of arthritis AS affects more men than women Onset is often in

More information

Polymyalgia Rheumatica www.arthritis.org.nz

Polymyalgia Rheumatica www.arthritis.org.nz Polymyalgia Rheumatica www.arthritis.org.nz Did you know? Arthritis affects one in six New Zealanders over the age of 15 years. Polymyalgia rheumatica is a common rheumatic condition. It affects more women

More information

Knee Arthritis and Total Knee Replacement DR. GREG TAYROSE UNIVERSITY ORTHOPEDICS AND SPORTS MEDICINE

Knee Arthritis and Total Knee Replacement DR. GREG TAYROSE UNIVERSITY ORTHOPEDICS AND SPORTS MEDICINE Knee Arthritis and Total Knee Replacement DR. GREG TAYROSE UNIVERSITY ORTHOPEDICS AND SPORTS MEDICINE Arthritis What is arthritis? What are the symptoms of arthritis? What is the physical exam a physician

More information

-- OTREXUP : The First Proprietary Product Featuring the VIBEX Medi-Jet Technology, an Easy-to-Use, Patient Friendly Auto Injector--

-- OTREXUP : The First Proprietary Product Featuring the VIBEX Medi-Jet Technology, an Easy-to-Use, Patient Friendly Auto Injector-- OTREXUP (METHOTREXATE) INJECTION APPROVED BY FDA A NEW TREATMENT FOR ADULTS WITH RHEUMATOID ARTHRITIS, CHILDREN WITH POLYARTICULAR IDIOPATHIC ARTHRITIS, AND ADULTS WITH PSORIASIS -- OTREXUP : The First

More information

Coping with. Chronic Lymphocytic Leukaemia (CLL) Patient information

Coping with. Chronic Lymphocytic Leukaemia (CLL) Patient information Coping with Chronic Lymphocytic Leukaemia (CLL) Patient information What is CLL? Your doctor will have told you that you have a condition that affects your blood called CLL. CLL is short for Chronic Lymphocytic

More information