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Assignment NR 602 Soap Note -Juvenile RA

Assignment: NR 602 Soap Note -Juvenile RA

Juvenile Idiopathic Arthritis (Juvenile RA)

JIA, formerly known as juvenile rheumatoid arthritis (JRA), now encompasses several disorders that have a common feature of arthritis (e.g., enthesitis-related arthritis and psoriatic arthritis) and had not been identified under the nomenclature of JRA (Wu et al, 2011). The diagnosis of JIA requires a persistent arthritis for more than 6 weeks in a pediatric patient younger than 16 years old. Table 25-1 shows the most current classification system.

TABLE 25-1

Juvenile Idiopathic Arthritis Subtypes and Clinical Joint Characteristics

Juvenile Idiopathic Arthritis Subtype Clinical Joint Characteristics
Oligoarticular Four or less joints with persistent disease never having more than four-joint involvement and extended disease progressing to more than four joints within the first 6 months
Polyarticular (RF negative) Five or more joints with symmetrical involvement
Polyarticular (RF positive) Symmetric involvement of both small and large joints with erosive joint disease
Systemic Either polyarticular or oligoarticular disease
Enthesitis-related arthritis Weight-bearing joints involved especially hip and intertarsal joints and a history of back pain, which is inflammatory in nature or sacroiliac joint involvement
Psoriatic arthritis Asymmetric or symmetric small or large joints

RF, Rheumatoid factor.

The underlying cause of most forms of JIA is unclear; however, it is a heterogenous disorder. It is likely environmentally induced in genetically predisposed …

NR 602 Soap Note -Juvenile RA

The presence of autoantigens from cartilage and joint tissue leads to activation of the T cells and results in release of proinflammatory …

NR 602 Soap Note -Juvenile RA

Clinical Findings


The major complaints in all forms of JIA are from the arthritis characterized by:

  • Pain—generally a mild to moderate aching
  • Joint stiffness—worse in the morning and after rest; arthralgia may occur during the day
  • Joint effusion and warmth

Systemic symptoms are found more commonly in systemic and polyarticular subtypes and include anemia, anorexia, fever, fatigue, lymphadenopathy, salmon-colored rash (SJIA), and weight loss. Growth abnormalities can result in localized growth disturbances, including premature fusion of the epiphyses, bony overgrowth (rheumatoid nodules), and limb-length discrepancies.

NR 602 Soap Note -Juvenile RA

Physical Examination

Associated features are:

  • Non-migratory monoarticular or polyarticular involvement of large or proximal interphalangeal joints for more than 3 months
  • Systemic manifestations—fever, salmon-colored rashes, leukocytosis, serositis, lymphadenopathy, and rheumatoid nodules

Less commonly seen are ocular disease (e.g., iridocyclitis, iritis, or uveitis), pleuritis, pericarditis, anemia of chronic disease, fatigue, and growth failure, or leg-length discrepancy if the arthritis is unilateral.

Key physical findings are:

Assignment NR 602 Soap Note -Juvenile RA

Assignment NR 602 Soap Note -Juvenile RA

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  • Swelling of the joint …

There are five major types of JIA (Gowdie and Tse, 2012):

  1. Oligoarticular pattern: This type of JIA involves …
  2. Polyarticular pattern: This involves five or more joints and is divided …
  3. SJIA: This is characterized by arthritis in one or more joints for 6 weeks’ duration in a child younger than 16 years old …
  1. Enthesitis-related JIA: This typically entails arthritis of the lower limbs especially the hip and intertarsal joints with the sacroiliac joints …
  2. Psoriatic arthritis: This is more common between the ages of 2 and 4 and again between 9 to 11 years old. There is usually a family history of psoriasis, or the child has psoriasis; however, the arthritis can precede the psoriasis by years. There can be dactylitis or a sausage-like swelling of the digits; involvement in the small digits is not uncommon.

NR 602 Soap Note -Juvenile RA

Diagnostic Studies

JIA is a diagnosis of exclusion. The diagnosis is based on physical findings and history of arthritis lasting for 6 weeks or longer. There is no diagnostic laboratory test for JIA. Most children with oligoarticular …

Differential Diagnosis

The various causes of monoarticular arthritis are part of the differential diagnosis. However, Lyme disease must be excluded and other differentials, including tumors, leukemia, cancer, bacterial infections, toxic synovitis, rheumatic fever, SLE, spondyloarthropathies, inflammatory bowel disease, septic arthritis, and chondromalacia patellae, need to be carefully considered.

NR 602 Soap Note -Juvenile RA


A specialist in pediatric rheumatology should follow children with severe involvement. Ophthalmology referral and evaluation is critical in a child with a positive ANA. Uveitis needs immediate ophthalmologic management. It is most common in oligoarticular JIA and is highly associated with a positive ANA. Other pediatric subspecialists, such as orthopedists, pain management specialists, and cardiologists, may be consulted as needed. Therapy depends on the degree of local or systemic involvement.


The main treatment goals are to suppress inflammation, preserve and maximize joint function, prevent joint deformities, …

Pharmacologic agents commonly used in the management of JIA include the following (Gowdie and Tse, 2012):

  • NSAIDs: Children with oligoarthritis generally respond well to NSAIDs (Taketomo et al, 2014).
  • Ibuprofen: …

NR 602 Soap Note -Juvenile RA

Complications and Prognosis

Systemic involvement can include iridocyclitis, uveitis, pleuritis, pericarditis, anemia, fatigue, and hepatitis. Residual joint damage caused by granulation of tissue in the joint space can occur. Children most likely to develop permanent crippling disability include those with hip involvement, unremitting synovitis, or positive-RF test.

The course of the disease is variable, and there is no curative treatment. Again, early aggressive treatment is critical; therefore, referral to a specialist is important. After an initial episode, the child may never have another episode, or the disease may go into remission and recur months or years later. The disease process of JIA wanes with age and completely subsides in 85% of children; however, systemic onset, a positive RF, poor response to therapy, and the radiologic evidence of erosion are associated with a poor prognosis. Onset of disease in the teenage years is related to progression to adult rheumatoid disease.

Important information for writing discussion questions and participation

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

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