Simone

Simone

General Info
1. Plays netball
  1. Swelling and redness
    1. Increased in the past 6 months
    2. After game
2. Swims
3. 9 yr old
  1. HAQ 5/24
    1. Not great for age
4. Pain in knees, wrists, and hand.
  1. Diagnosed Juvenile Idiopathic Arthritis
    1. X ray
      1. Osteopenia
    2. Pauciarticular
    3. Pathophysiology of JIA
      1. Body can't distinguish between healthy tissue and bad tissue
        Increased inflammatory response
        Cell proliferation
        Synovial membrane mass
        Soften and weaken cartilage
        Erodes cartilage
        Erodes joint
        Laxity of ligaments and capsule
        Increased articular pressure
        Surrounding soft tissue fibrosis and contracture
        Pannus
        Stiffening of joint cavity if uncontrolled
        Thickens
        increased synovial fluid (effusion)
        Increase in pressure
        Increased cytokines
      2. Not sure what causes it
      3. Form of RA
        JIA effects growth
    4. Diagnosis
      1. 3 types
        Poly
        More than 5 joints
        Pauci
        Best prognosis
        4 joints or less in first 6 months
        Spontaneous recovery
        Systemic
        Fever, rash
      2. If lasts for more than 6 weeks
    5. Diff Diagnosis
      1. Osgood Schaltter's
        Avulsion of quad tendon
        NOT
        Prominent tib tuberosity
        X ray
        No tight quads/hammys
      2. Haemophilia
        Blood doesn't clot
        NOT
        No nose bleeds
        Need to be vary due to medication
      3. Bechets Disease
        Autoimmune
        NOT
        Painful mouth sores
        Inflamed eyes
        Skin lesions
      4. Kawasaki
        NOT
        Neck swollen
        Swollen
        No fever
      5. Systemic Lupus
        NOT
        Skin rashes
        Fatigue
        Fever, no cause
        Chest pain
        Generally ill
        Abnormal heart rythms
    6. Medical Management
      1. Steroid Injections
        Bad for bones
        Common after NSAIDs
        Immobilize post injection
        Not after wrist
        Good for knee
      2. Biological Therapy
        Infection
        Blocks activity of cytokines
        and other cells involved in immune response
      3. Surgery
        Wrist uncommon
        TKA
        Bones already deformed and weak
        Not great outcome in kids
        THA
        Improved function and pain relief
        Surgery is challenging due to poor bone quality
        Hip affected in 1/3 of JIA
    7. Physio Management
      1. Acute
        Manage pain
        Rest
        Avoid excessive fatigue
        Exercise doesn't progress disease
        Ice packs
        Heat packs at night
        PROM involvement
        Kids enjoy AROM
        Isometric
        Load management
      2. Chronic
        Fitness levels often low
        Retrain gait
        Maintenance
        Exercise program
        Hydro
        Land
        Cycling
        Psychological?
5. Medication
  1. Methotrexate
    1. Strict guidelines
      1. Needs to be constantly monitored
      2. Used to combat cancer
      3. 1 per week
      4. Best 3 days post
      5. Affects kidneys
      6. Needs to be constantly monitored
    2. Inhibits replication of cells in the body
    3. Inhibits DNA synthesis
    4. Stops folic acid production
      1. Taken in conjunction with folic acid
        Helps reproduce good cells
      2. Reduces production of cells that attack joints
  2. NSAIDs
    1. Naprosyn
    2. Large variety
Living with JIA for a 9 yr old
1. Cycling with friends
2. Relay swimming teams
3. Dances
4. Doesn't want a splint or stand out

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	Created by MariaE over 8 years ago