Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory synovial disease usually affecting children. Girls are more frequently affected than boys. This disease exhibits many of the features of adult rheumatoid arthritis. There are three additional features that are almost pathognomonic of this condition, if these are present. First is periosteal reaction that is usually seen along the shafts of the proximal phalanges and metacarpals, next is joint ankylosis that may occur not only in the wrist but also in the interphalangeal articulations (Fig. 4.25). Fusion of the apophyseal joints of the cervical spine is a characteristic finding (Fig. 4.26), in addition to fusion of the posterior elements. The last of the pathognomonic features is growth abnormality. Altered bone growth is a common finding because the onset of JRA usually occurs before the closure of the growth plates. Involvement of the epiphyseal regions often leads to fusion of the growth plates with resultant retardation of bone growth. Paradoxically, this might also precipitate premature acceleration of growth due to stimulation of the growth plate by resultant hyperemia. The enlargement of the epiphyses of the distal femur usually leads to characteristic overgrowth of the condyles in the knee [5] (Fig. 4.27).

The implication for anesthesia is that there is limited mobility of the spine due to the bony ankylosis, and there is usually micrognathia due to the growth disturbance. These factors can make intubation extremely difficult.

Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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