Juvenile idiopathic arthritis: Viva

This is a branching oral built to probe the reasoning that holds the classification, the uveitis and the treat-to-target therapeutics at the centre, and to expose the candidate who has memorised the headline without the safety-critical corners. The questions escalate from the framing to the classification, the uveitis, the methotrexate and the biologics, with deliberate probes into the septic-arthritis mimic and the biologic infection. [2]

Opening question: framing the problem

The examiner opens with the swollen knee for ten weeks and asks: how do you frame this problem in a single sentence, and what is your first step? [2]

A strong answer names the oligoarticular juvenile idiopathic arthritis from the ten-week duration, the morning stiffness and the single joint, and states that the first step is the slit-lamp for the uveitis and the exclusion of the mimics. [2]

Model answer. This child has the oligoarticular juvenile idiopathic arthritis from the arthritis of one joint for more than six weeks in a child under sixteen, with the morning stiffness that improves with activity. The first step is the slit-lamp for the chronic anterior uveitis, because she is young, antinuclear-antibody positive and oligoarticular, which is the highest-risk profile, and the full joint examination and the exclusion of the septic arthritis and the mimics. [1][2]

Probe one: the classification

The examiner presses: describe the ILAR classification, and tell me which subtype is the commonest and what the persistent-versus-extended split means. [1]