Question

Investigation in Juvenile Idiopathic Arthritis.

Hint:

Regular ophthalmologic screening is crucial in JIA, especially in ANA-positive patients, as uveitis is a potentially serious complication.

Answer 1

Investigating Juvenile Idiopathic Arthritis (JI involves both clinical and laboratory tests to confirm the diagnosis, identify the subtype, and exclude other conditions. Common investigations include:
1. Blood Tests:
- C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): These are markers of inflammation and are often elevated in active disease.
- Complete blood count (CBC): Often shows anemia (due to chronic disease) and leukocytosis (in the systemic type).
- Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP): These tests are typically negative in JIA but may be positive in some cases (especially in polyarticular JI.
- Antinuclear antibody (AN: Commonly positive in children with oligoarticular JIA, and it can be associated with an increased risk of uveitis.
2. Imaging:
- X-rays: Used to assess joint damage, erosion, and inflammation. In early stages, X-rays may be normal.
- Ultrasound: Can detect early joint inflammation, synovial fluid accumulation, and soft tissue changes.
- MRI: Useful in evaluating early joint changes, especially in the spine and hip.
3. Ophthalmologic Examination:
- Slit-lamp examination: Regular eye exams are essential to monitor for uveitis, a common complication of JIA, particularly in those with ANA-positive oligoarticular JIA.