A Brief Look at Juvenile Rheumatoid Arthritis

Will Oliver, BSN, RN

Lubbock Christian University

NUR 5200

Introduction to Graduate Studies

Advanced Practice Presentation

Submitted to

Daniel Hatch, DNP, APRN, FNP-BC

Bev Byers, EdD, RN, LMT, LMTI

July 24, 2014

Juvenile Rheumatoid Arthritis

• Adolescents and children, age 16 and younger(“Childhood arthritis,” 2013)

• Joint inflammation and stiffness lasting 6 weeks or longer (“Childhood arthritis,” 2013)

• Pediatric nursing implications

Pathophysiology

• Malfunction of the immune system– Following infectious disease or other unknown triggers

• Inflammatory factors attack synovial membrane– Unchecked inflammation can cause joint damage 

(Abramson, 2013)

Pathophysiology

(“Childhood arthritis,” 2013)

• Three classifications:–Oligoarticular - 50% –Polyarticular – 40%– Systemic - 10% 

• Criteria:–Number of joints affected– Symptoms–Potential presence of antibodies

Subjective Patient Presentation

• limping• morning stiffness• favoring one or more limbs• inactivity• lingering fever• noticeable joint inflammation• difficulty with fine motor skills         

(Abramson, 2013)

Objective Patient Presentation

• Thorough observation                                   (Abramson, 2013)

• May have presence of antibodies               (“Childhood arthritis,” 2013)

• Presence of elevated CRP and ESR             (“Childhood arthritis,” 2013)

http://www.webmd.com/rheumatoid-arthritis/ss/slideshow-ra-overview

Diagnosis

• Joint inflammation 6 weeks – 3 months

• Age 16 and under

• Imaging

• Rule out other childhood diseases(Abramson, 2013)

Pharmacological Intervention

            (Prince, Otten, van Suijlekom-Smit, 2011, Diagram 1, p. 98)   

Non-Pharmacologic Intervention

• Initiating a multidisciplinary team to include regular check-ups  (Prince et al., 2011)

http://www.cbc.ca/news/canada/hamilton/news/report-helps-healthcare-workers-spot-fabricated-illness-in-kids-1.1304273

=http://www.knoxnews.com/news/2012/dec/01/teen-turns-her-energy-toward-fighting-juvenile/

http://my.clevelandclinic.org/childrens-hospital/specialties-services/departments-centers/rheumatology/default.aspx

Patient Education and Counseling

• Early intervention–Correct diagnosis– Effective treatment–Multidisciplinary approach

• Psychological well-being –Child–Parent 

(Vuorimaa et al., 2009)

http://thecertainonesmagazine.com/juvenile-arthritis-awareness-month/

Conclusion

References

Abramson, MD, L. S. (2013).  Arthritis in children.  

Retrieved from http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Arthritis_in_Children/

Childhood arthritis. (2013). Retrieved from http://www.cdc.gov/arthritis/basics/childhood.htm

Reynolds, G. (2012). Presentation Zen: Simple ideas on presentation design and delivery (2nd ed.). Berkley, CA: New Riders.

Prince, F. H. M., Otten, M. H., & van Suijlkom, L. W. A. (2011). Diagnosis and management of juvenile idiopathic arthritis. British

Medical Journal (Overseas & Retired Doctors Edition), 342(7788), 95-102. doi:10.1136/bmj.c6434

Singh, G. (1994). Childhood health assessment questionnaire. Retrieved from http://www.rheumatology.org/Search.aspx?

SearchText=CHAQ

Vuorimma, H., Tamm, K., Honkanen, V., Konmulainen, E., Konttinen, Y. T., & Santavirta, N. (2009). Parents and children as agents 

of disease management in Juvenile Idiopathic Arthritis. Child: Care, Health & Development, 35(4), 578-85. 

doi:http://dx.doi.org/10.1111/j.1365-2214.2009.00981.x