Migraines in pregnancy
Q: During childhood a patient was diagnosed with rheumatoid arthritis affecting hands and knees. Now in her 20s she has joint pains. There is no erythema but the finger joints occasionally swell. All tests are negative. Can you 'grow out' of juvenile RA?
A: Some 70 per cent of children will grow out of juvenile idiopathic arthritis (JIA). The term covers several distinct clinical syndromes and the number of joints involved is the most useful classification. Oligoarthritis (fewer than five joints involved) comprises about 70 per cent of JIA and is generally milder, carrying the best prognosis. The remaining 30 per cent have polyarthritis.
I believe your patient falls into the 25 per cent whose systemic variety is serogenetive (now adult rheumatoid) and is in the 60 per cent who will have a recurring but low-grade arthritis.
The other 40 per cent is made up of those whose condition will go into remission (25 per cent) and those who will go on to develop severe arthritis (15 per cent). Of this percentage a quarter of patients will have the systemic variety (Still's disease).
For your patient, knowledge of early-morning stiffness and current inflammatory markers (CRP and plasma viscosity) would be useful, and she would probably benefit from a team-based approach, including rheumatologist, physiotherapist and occupational therapy and may benefit from DMARDs.
Dr Ross Duff is a GPwSI and clinical assistant in rheumatology in Angus, Tayside