Rheumatologic disorders

Abstract

Juvenile idiopathic arthritis (JIA) is the most common inflammatory joint disorder in childhood. The presentation can be oligoarticular, polyarticular, or systemic. The oligoarticular is the most difficult to diagnose and the patients often present with a history or “trauma.” A careful history and physical supplemented by x-rays is the mainstay to accurate diagnosis. Marked changes in carpal alignment and advanced skeletal maturity are the hallmark x-ray findings. Coordinated care between the hand surgeon and pediatric rheumatologist provides the optimum care for the patient and family. The management of JIA has changed considerably within the last 10–15 years with the recognition that earlier treatment limits irreversible articular cartilage and promotes better outcomes. The introduction of disease-modifying drugs and biologic agents has altered the clinical and radiographic consequences of the disease. This chapter will include the diagnostic approach, pharmacological management, and surgical considerations of children with pediatric elbow, hand, and wrist inflammatory arthritis.