ESTER Reumatologia: Paediatric Rheumatology and Related Disciplines

Juvenile idiopathic arthritis (JIA) is arthritis of unknown cause beginning before age 16 and lasting at least six weeks. Subtypes matter for exams:

Oligoarticular: fewer than five joints, often knee or ankle; high risk of chronic uveitis, especially with positive ANA - requires regular slit-lamp screening even when the eyes look and feel normal.
Polyarticular: five or more joints; rheumatoid factor positive disease behaves like adult rheumatoid arthritis.
Systemic: quotidian fevers, evanescent rash, serositis, very high inflammatory markers; watch for macrophage activation syndrome.
Enthesitis-related and psoriatic: enthesitis, HLA-B27, axial involvement, psoriasis or nail changes.

Kawasaki disease: fever for five or more days plus conjunctivitis, mucosal changes, rash, extremity changes and cervical lymphadenopathy; risk of coronary aneurysms, so treat with intravenous immunoglobulin and aspirin.
Henoch-Schönlein (IgA) vasculitis: palpable purpura on the legs, abdominal pain, arthritis and nephritis.
Growing pains: bilateral, evening, relieved by massage, no morning restriction.
Septic arthritis and osteomyelitis: a child with a hot joint, fever and reluctance to move needs urgent aspiration and antibiotics.
Chronic musculoskeletal pain and hypermobility: assess function and reassure appropriately without missing inflammatory disease.

A child with a limp or refusing to walk must have infection and malignancy excluded.
Normal inflammatory markers do not exclude uveitis; screening is scheduled by subtype and ANA status.
Fevers that are quotidian and accompanied by a rash suggest systemic JIA rather than infection.

In a child with joint swelling, look at the eyes and ask about fevers - uveitis and systemic disease are the complications questions target.