Ocular Manifestations in Juvenile Arthritis
The histocompatibility of human leukocyte antigen B27 (HLA-B27) is detected in a large percentage of patients in this subgroup. Children should not be included in this subgroup solely because of…
Hand Involvement in Juvenile Arthritis
Rheumatoid Factor–Negative Polyarthritis. Approximately 75% of patients with polyarticular-onset arthritis do not have IgM rheumatoid factor in the serum, and the rheumatoid factor test rarely becomes positive 6 months after…
Lower Limb Involvement in Juvenile Arthritis
Ocular involvement of any type is uncommon in patients with the systemic-onset form. Central nervous system (CNS) involvement, including seizures, has been reported but is considered rare. The majority of…
Systemic Juvenile Arthritis (Continued)
POLYARTICULAR-ONSET ARTHRITIS About 20% to 25% of children with juvenile arthritis exhibit polyarticular onset, which is characterized by involvement of five or more joints and the absence of significant systemic…
Systemic Juvenile Arthritis
In 2004, major changes were made to the classification of children with JIA. Based on expert consensus, children with JIA were subclassified into seven subtypes: oligoarticular (either persistent or extended),…
Synovial Fluid Examination (Continued)
The leukocyte count helps determine if the joint effusion reflects an inflammatory or noninflammatory process. Synovial fluid is usually heparinized before the cell count to reduce clumping. Leukocyte counts greater…
Synovial Fluid Examination
The clarity of the fluid is assessed by experienced clinicians in the syringe but more reliably can be done by expressing a small amount of fluid out of the plastic…
Techniques for Aspiration of Joint Fluid
Although arthrocentesis can be performed by experienced clinicians using clinical landmarks, aspiration and injection of deeper joints (hip), complicated joints (wrist), and even large joints such as the knee and…
Surgical Management in Rheumatoid Arthritis
The first agents in this category were inhibitors of TNF-α (anti–TNF-α agents). Currently, five of these drugs have been approved by the U.S. Food and Drug Administration: • Adalimumab (fully…
Exercises for Shoulders and Lower Extremities
Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs interfere with the production of prostaglandins and thus are effective in the reduction of inflammation and, therefore, pain. Many patients will require these agents along…
