Juvenile-onset spondylarthropathy Health Dictionary

Previously called juvenile rheumatoid arthritis and juvenile chronic arthritis, this is a set of related conditions of unknown cause affecting children. Characteristically, the synovial membrane of a joint or joints becomes in?amed and swollen for at leat six weeks (and often very much longer – even years). About 1 in 10,000 children develop it each year, many of whom have certain HLA genetic markers, thought to be important in determining who gets the illness. In?ammatory CYTOKINES play a big part.

Clinical features There are various types. The oligoarthritic type involves 1–4 joints (usually knee or ankle) which become hot, swollen and painful. One complication is an in?ammation of the eyes – UVEITIS. The condition often ‘burns out’, but may reappear at any time, even years later.

The polyarthritic type is more like RHEUMATOID ARTHRITIS in adults, and the child may have persistent symptoms leading to major joint deformity and crippling.

The systemic type, previously called Still’s disease, presents with a high fever and rash, enlarged liver, spleen and lymph nodes, and arthritis – although the latter may be mild. In some children the illness becomes recurrent; in others it dies down only to return as polyarthritis.

Complications These include uveitis, which can lead to loss of vision; a failure to thrive; osteoporosis (see under BONE, DISORDERS OF); joint deformity; and psychosocial diffculties.

Treatment This includes ANTIPYRETICS and ANALGESICS, including NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), intra-articular steroid injections, anti-tumour necrosis factor drugs and steroids.

Physiotherapy is vital, and children may need to wear splints or other orthotic devices to alleviate deformity and pain. Orthopaedic operative procedures may be necessary.... juvenile idiopathic arthritis (jia)

A group of rheumatoid conditions of unknown causation with onset before 16 years. Girls more than boys. Still’s disease being the form presenting with enlargement of spleen and lymph nodes, high temperature with macular rash comes and goes. Children usually ‘grow out of it’ although stiffness may continue. Deformities possible. Tardy bone growth of the mandibles giving the face a birdlike look. May progress to rheumatoid arthritis (girls) or ankylosing spondylitis (boys). So strong is psychosomatic evidence that sociologists believe it to be a sequel to broken families, divorce or bereavement. Few patients appear to come from a balanced environment or happy home.

Treatment. BHP (1983) recommends: Meadowsweet, Balm of Gilead, Poke root, Bogbean, Hart’s Tongue fern, Mountain Grape.

Teas: Singly or in combination (equal parts): Chamomile, Bogbean, Nettles, Yarrow. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup thrice daily before meals.

Tablets/capsules. Blue Flag root, Dandelion root, Poke root, Prickly Ash bark.

Formula. White Poplar bark 2; Black Cohosh half; Poke root quarter; Valerian quarter; Liquorice quarter. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon) (children 5-12 years: 250mg – one 00 capsule or one-sixth teaspoon). Liquid extracts: 1 teaspoon: (children 5-12: 3-10 drops). Tinctures: 2 teaspoons: (children 5-12: 5-20 drops).

Evening Primrose oil. Immune enhancer.

Topical. Hot poultice: Slippery Elm, Mullein or Lobelia.

Diet: Lacto vegetarian. Kelp. Comfrey tea. Molasses. Low fat.

General. Adequate rest, good nursing, gentle manipulation but no massage to inflamed joints. Natural lifestyle. Parental emotional support.

Oily fish. See entry. ... arthritis, juvenile, chronic

See juvenile chronic arthritis.... juvenile arthritis

A rare form of arthritis affecting children. Juvenile chronic arthritis occurs more often in girls, and usually develops between 2 and 4 years of age or around puberty. There are 3 main types. Still’s disease (systemic onset juvenile arthritis) starts with fever, rash, enlarged lymph nodes, abdominal pain, and weight loss. These symptoms last for a period of several weeks. Joint pain, swelling, and stiffness may develop after several months. Polyarticular juvenile arthritis causes pain, swelling, and stiffness in many joints. Pauciarticular juvenile arthritis affects 4 joints or fewer.

Possible complications include short stature, anaemia, pleurisy, pericarditis, and enlargement of the liver and spleen. Uveitis may develop, which, if untreated, may damage vision. Rarely, amyloidosis may occur or kidney failure may develop. Diagnosis is based on the symptoms, together with the results of X-rays and blood tests, and is only made if the condition lasts for longer than 3 months.

Treatment may include antirheumatic drugs, corticosteroid drugs, nonsteroidal anti-inflammatory drugs, or aspirin. Splints may be worn to rest inflamed joints and to reduce the risk of deformities. Physiotherapy reduces the risk of muscle wasting and deformities.

The arthritis usually clears up after several years. However, in some children, the condition remains active into adult life.

– kala-azar A form of leishmaniasis that is spread by insects. Kala-azar occurs in parts of Africa, India, the Mediterranean, and South America.... juvenile chronic arthritis

A raised, reddishbrown skin blemish which sometimes appears on the face or legs in early childhood (see naevus). Although they are usually harmless, an unsightly growth,or one suspected of being skin cancer, can be removed surgically.... melanoma, juvenile

see dermatosis.... juvenile plantar dermatosis

see polyp.... juvenile polyp

a mental disorder characterized by systematic *delusions and commonly auditory *hallucinations, but without any other marked symptoms of *mental illness; it was formerly known as paraphrenia. The only loss of contact with reality is in areas affected by the delusions and hallucinations. It is typically seen in the elderly and can also occur in people with severe hearing impediments. Some people develop other symptoms of *schizophrenia over time but in many the personality remains intact over years. *Antipsychotic medication is often useful in treating the illness.... late-onset schizophrenia

(JIA, Still’s disease) any one of a group of conditions characterized by inflammation of the joints lasting longer than 6 weeks and occurring before the age of 16. The causes are unknown but immunological and infective mechanisms are suspected. JIA can affect either four or fewer joints (pauciarticular JIA) or more than four (polyarticular JIA). There are two recognized types of pauciarticular JIA: type 1, which generally affects girls below the age of four; and type 2 (juvenile-onset spondylarthropathy), which generally affects boys over the age of nine. There are also two types of polyarticular JIA, depending on the presence or absence of a particular antibody in the blood. There is a great range of severity of these diseases. Treatment consists of pain management and prevention of subsequent deformity or limitation of movement (e.g. contractures). Long-term joint damage is prevented by use of medications similar to those used in rheumatoid arthritis.... juvenile idiopathic arthritis

(MODY, monogenic diabetes) a range of rare but important forms of type 2 *diabetes mellitus caused by a single autosomal *dominant genetic defect. The two commonest forms are mutations of the HNF-1? gene (MODY 3), which often responds to treatment with *sulphonylurea drugs, and mutations of the glucokinase gene (MODY 2), causing a mild elevation of blood glucose levels usually responsive to dietary management.... maturity-onset diabetes of the young