Juvenile rheumatoid arthritis: The Daily PANCE Blueprint

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Juvenile rheumatoid arthritis: The Daily PANCE Blueprint

A 14-year-old male presents to the clinic complaining of pain in his joints (especially his knees and ankles). He says it has been going on for the past few months. He also has had worsening fatigue, stiffness, and fevers. Labs reveal elevated ESR and CRP, as well as elevated ANA. Which of the following is the first-line treatment for this most likely diagnosis?

A. Abatacept
B. Sulfasalazine
C. Indomethacin
D. Tylenol
E. Systemic corticosteroid

Answer and topic summary

The answer is C. Indomethacin

Juvenile rheumatoid (idiopathic) arthritis is a group of disorders that are defined by joint inflammation for more than 6 weeks in people younger than 16. There are different types (oligoarticular, systemic, psoriatic, polyarticular, and enthuses) and each has different joint involvement patterns and extra-articular manifestations. Clinical features include swollen joints, morning stiffness, fever, rash, uveitis, lethargy, growing pains, and lymphadenopathy. Diagnostic tests can include RF level, ANA, anti-CCP, ESR, CRP, CBC, US, synovial biopsy, and split lamp examination. 1st line of therapy is NSAIDs (e.g., indomethacin); the second line is DMARDs or biologics.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Disorders ⇒ Juvenile rheumatoid arthritis

Also covered as part of the Pediatric EOR topic lists

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