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1. Info

   • Wants to be part of a team.
   • Netball
     • How much is good?
     • Mother is concerned
     • Swollen hands and wrists after
       • Interview
         • Medical History
           • Viral Infections
             • Juvenile Idiopathic Arthritis
               • Sees rheumatologist every 6 months
           • Often very tired
             • Very stiff
           • First walked at 2 yrs old.
             • 6 months delayed
           • Current
             • Naprosyn
               • Initially not helpful
               • NSAID
               • Reduces hormones that causes inflammation and pain
             • Methotrexate
               • Used as a secondary, after others don't work
               • Interferes with cell production
               • Beneficial for 12-52 weeks
               • Chemo drug
               • No unexpected LOW
             • Folic acid
               • Assists in cell production
               • Works with methotrexate to counteract the negative effects
               • Greater risk of having cancer when taken with methotrexate
             • Physio Assessment
               • Current 3/10 pain
               • HAQ 5/24
                 • Good score
                 • No activity limitation
                 • Turning off hard taps
                 • Getting out of low seats
               • Swimming 4x25 per week
                 • Little athletics on sat mornings
                 • Netball
                   • Swollen after
                     • 4 days
               • Full AROM both legs
               • Wrists tender to palpate
                 • Good grip strength
               • Knees puffy and tender
                 • L warmer than R
                 • R weaker than L
               • Recent growth spurt
                 • New shoes
                   • Comfy
                   • Pretty
               • X ray
                 • Osteopenia
                   • Mineral content is reduced
                 • Pauciarticular Juvenile RA
                   • 4 or fewer joints involved
                   • Affects bigger joints.
                   • Linked to eye problems
         • Eases
           • Swimming
             • Water good on joints
         • Family history
           • Great aunt has RA and SLE
             • NWB in wheelchair
             • Waiting for TKA
             • Contractures in wrist
         • Social History
           • 2 young sisters
           • Misses school occasionally
           • Good friends
     • Swollen knees after
       • Painful
       • Increased redness and swelling in wrist past 6 months
   • 9 yrs old