Juvenile idiopathic arthritis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2] Nehal Eid, M.D.[3]

Overview

The physical manifestations of juvenile idiopathic arthritis include joint swelling, pain, stiffness, and limited range of motion, often accompanied by gait abnormalities and functional impairment. Extra-articular findings such as fever, rash, lymphadenopathy, uveitis, and growth disturbances may occur depending on the disease subtype and severity.

Physical Examination

Physical examination in juvenile idiopathic arthritis (JIA) focuses on identifying signs of active arthritis, assessing functional impairment, and detecting extra-articular involvement.

Musculoskeletal Examination

• Joint swelling, warmth, and effusion
• Pain or tenderness on palpation or movement
• Limitation of range of motion
• Joint deformities or contractures in chronic disease
• Enthesitis can have calcaneal/peripatellar affection. It may also have axial involvement.
• Limb-length discrepancy or asymmetry due to growth-plate hyperemia
• Tempromandibular joint affection can lead to micrognathia or jaw dysfunction
• Gait abnormalities

Systemic Examination

• Fever pattern, particularly quotidian fevers in systemic JIA
• Evanescent salmon-pink rash, often accentuated during fever spikes
• Lymphadenopathy
• Hepatosplenomegaly
• Signs of serositis, including pericardial or pleural involvement

Ocular Examination

• Screening every 3 to 6 months for chronic anterior uveitis, which is typically asymptomatic
• Regular slit-lamp examination is recommended, especially in high-risk subtypes
• Acute anterior uveitis presents with a rapid onset of eye pain, conjunctival erythema and photophobia.

Growth and Development

• Assessment of height and weight for growth retardation
• Evaluation of facial symmetry and jaw movement for temporomandibular joint involvement

A comprehensive physical examination should be performed at each visit to monitor disease activity, identify complications, and guide treatment decisions.