Oligoarticular juvenile idiopathic arthritis
- Pamela F Weiss, MD, MSCE
Pamela F Weiss, MD, MSCE
- Assistant Professor
- Department of Pediatrics
- University of Pennsylvania
- Children's Hospital of Philadelphia
Oligoarticular juvenile idiopathic arthritis (formerly called pauciarthritis or pauciarticular-onset juvenile rheumatoid arthritis) is defined as juvenile idiopathic arthritis (JIA) involving fewer than five joints. It is the most common subgroup, constituting approximately 50 percent of cases of JIA (table 1). This subgroup of JIA is further divided into persistent oligoarthritis, in which there is no additional joint involvement after the first six months of illness, and extended oligoarthritis, in which there is involvement of additional joints after the first six months such that more than four joints are ultimately affected . Approximately 50 percent of children with oligoarticular disease go on to have extended oligoarticular disease . Extended oligoarticular JIA is distinct from polyarticular JIA. (See "Classification of juvenile arthritis".)
The clinical issues related to oligoarticular JIA are discussed in this topic review. Systemic JIA, polyarticular JIA, and psoriatic JIA are discussed separately. The epidemiology, classification, and immunopathogenesis of JIA are also discussed separately. (See "Systemic juvenile idiopathic arthritis: Clinical manifestations and diagnosis" and "Polyarticular juvenile idiopathic arthritis: Clinical manifestations and diagnosis" and "Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis" and "Classification of juvenile arthritis" and "Juvenile idiopathic arthritis: Epidemiology and immunopathogenesis".)
Oligoarticular JIA affects females more often than males, as does polyarticular disease. The peak incidence of oligoarticular JIA is in the second and third years of life. It is less common over five years of age and rarely begins after age 10 years.
The typical child with oligoarticular JIA is a toddler girl who is noticed to be limping without complaint. Often, the family notices that the child "walks funny" in the morning, but after a little while seems fine. In many cases, the child has never complained of pain; the family seeks medical advice only because the knee is swollen. It is unusual for the family to be able to specify exactly when the illness started.
Oligoarticular JIA affects the large joints (knees, ankles, wrists, elbows), but virtually never begins in the hips. There are several other types of arthritis that may have oligoarticular onset in this age group, but are not JIA. Systemic manifestations (other than uveitis) are characteristically absent. Thus, fever, rash, or other constitutional symptoms suggest a different diagnosis. (See 'Differential diagnosis' below.)
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- CLINICAL PRESENTATION
- LABORATORY FINDINGS
- DIFFERENTIAL DIAGNOSIS
- COURSE AND PROGNOSIS
- Determining disease activity
- Prognostic markers
- Initial therapy
- Escalation of therapy
- Temporomandibular joint arthritis
- - Screening
- - Treatment and monitoring
- - Ocular complications
- Leg length discrepancy
- Short stature
- INFORMATION FOR PATIENTS