Juvenile Idiopathic Arthritis and Acute Rheumatic Fever

Juvenile Idiopathic Arthritis (JIA) is a group of diseases that starts before the age of 16 and is characterized by arthritis of at least one joint, lasting for more than 6 weeks and the origin of which is unknown. Symptoms of JIA include fever, rash, weakness, non-specific musculoskeletal pain and morning stiffness. Classification of JIA is based on symptoms that present during the first 6 months of the disease. Categories of JIA: systemic arthritis, oligoarthritis, a/persistent oligoarthritis b/extended oligoarthritis, polyarthritis (rheumatoid factor negative), polyarthritis (rheumatoid factor positive), psoriatic arthritis, enthesitis-related arthritis, undifferentiated arthritis. There are no serological markers which may indicate JIA at diagnosis, therefore it is important to exclude other conditions which may mimick arthritis. Initial treatment of children with arthritis begins with NSAIDs, intra-articular GCS and if these prove ineffective, methotraxate is used. Sulfasalazine, hydroxychloroquine or ciclosporin A may also be used. Biological therapies such as anti-TNFα, anti – IL1, IL6 blockade, abatacept show better improvement when they are added to methotrexate. Acute rheumatic fever is a systemic inflammatory disease which occurs 2-3 weeks after infection with group A β-hemolytic streptococci. The acute form is characterized by: fever, arthritis, which is usually migratory and affects predominantly large joints. Cardiac manifestations due to involvement of the pericardium, myocardium, endocardium and heart valves may also occur. Neurological involvement is in the form of Sydenham’s chorea. Bed rest and antimicrobial therapy with penicillin is essential. Salicylate doses of 4 g may be required in adults. GCS is used in patients with severe carditis.

Keywords: Acute rheumatic fever, Anti-TNFα, Ciclosporin A, Endocarditis, Enthesitis-related arthritis, GCS, Group A β-hemolytic streptococci, Hydroxychloroquine, Juvenile Idiopathic Arthritis (JIA), Methotraxate, NSAIDs, Oligoarthritis, Penicillin, Polyarthritis, Psoriatic arthritis, Salicylate, Sulfasalazine, Systemic arthritis, Undifferentiated arthritis.