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Vulva : Overview, Anatomy, structure and function - Sentelhealth

 Overview : The vulva is a part of the female reproductive system and is also part of the external genitalia. The vulva consists of labia minora, labia majora, mons pubis, clitoris, vestibular bulb, vulval vestibule, urinary meatus the vaginal opening, hymen, and Bartholin's glands. other parts of the vulva include sebaceous glands, urogenital triangle, and pudendal cleft. Pelvic floor muscles support the structures of the vulva and vulva including the entrance to the vagina. Vulva goes through changes during childhood, puberty, menopause, and post-menopause. Structure: A) Mons pubis: it is present in both sexes and act as a cushion during sexual intercourse and is more pronounced in female. the mons pubis is a soft fatty tissue at the front of the vulva in the pubic region covering the pubic bone. the lower part of the mons pubis is divided by a fissure called pudendal cleft. it separates mons pubis and labia majora, the mons pubis, and labia majora get covered by pubic hair at pu...
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Juvenile rheumatoid arthritis(JRA)| causes | symptoms | Types | Diagnosis | Treatment | complications | prognosis -Sentelhealth

Juvenile rheumatoid arthritis(JRA)| causes | symptoms | Types | Diagnosis | Treatment | complications | prognosis 


Overview 

Juvenile rheumatoid arthritis or Juvenile idiopathic arthritis is an autoimmune disorder in which the body mistakenly identifies some of its own tissue as foreign.
So, the immune system that helps in fighting bacteria and other infections begins to attack the normal healthy cells. Which results in inflammation, redness, heat, pain, and swelling.

Age group affected

Juvenile rheumatoid arthritis usually affects the child 16 years or younger. But, the peak incidence is seen between 8-14 years.
It affects approximately 50000 children in the united states.

Does Juvenile rheumatoid arthritis ever go away?

Juvenile rheumatoid arthritis disappears in 60-70% of children until adulthood. while adult rheumatoid arthritis has lifelong symptoms.

Lesser known facts about 
Juvenile rheumatoid arthritis

1) RA factor positivity is considered a bad prognostic factor for Juvenile rheumatoid arthritis.

2) Joint pain is not the symptom of Juvenile rheumatoid arthritis.

3)Female gender is a risk factor for Juvenile rheumatoid arthritis.


Risk factors

There are no identifiable risk factors for Juvenile rheumatoid arthritis but, it seems that some forms of Juvenile rheumatoid arthritis are more common in girls.

Causes

Mechanisms of development of Juvenile rheumatoid arthritis in children:

The exact mechanism of how Juvenile rheumatoid arthritis affects children is not clear however there are two theories that explain this.

A) Alteration in child's genetic makeup leading to the development of 
Juvenile rheumatoid arthritis.

B) environmental factors such as a virus or other infections trigger the development of Juvenile rheumatoid arthritis in children.

Signs and symptoms

The most consistent signs and symptoms of Juvenile rheumatoid arthritis are:

1) Fever:

In most cases, fever is the first symptom noticed by the patient.
Fever is typically high-grade Type and present thought the day.

2) Swelling:

Joint swelling occurs due to inflammatory changes at the joint. the swelling is typically noticed at larger joints first like a knee.

3) Stiffness:

Stiffness of a joint in Juvenile rheumatoid arthritis is also due to inflammation that occurs at the joint.
This symptom is more noticeable in the morning or after the naps.

4) Swollen lymph nodes and rash:

This can lead to misdiagnosis of infection. The rash-over trunk is typical of Juvenile rheumatoid arthritis and is worse in the evening hours.

5) pain:

Joint pain is not the feature of Juvenile rheumatoid arthritis and your child may not complain of pain but you may notice that he/she limps especially in the morning or after the nap.

Types of Juvenile rheumatoid arthritis:

1) Pauciarticular:

This is the most common type of Juvenile rheumatoid arthritis accounting for more than 50% of cases.
Four or fewer joints are involved in this type with typical affection to large joints such as the knee.
Some patients with this type of Juvenile rheumatoid arthritis show positive ANAs (Antinuclear antibodies) in their blood.
Girls, less than 8 years are most likely to develop this type.

2) Polyarticular:

This type typically involves five or more joints typically affecting small joints and joints of hands and feet are most commonly involved.
This type shows the presence of rheumatoid factor (a type of antibody) which is considered as the bad prognostic sign and is considered as the severe type of Juvenile rheumatoid arthritis with high chances that it will continue in adulthood.

3) Systemic:

It is also called a still's disease.it accounts for 20-30% of cases of Juvenile rheumatoid arthritis.
This type of Juvenile rheumatoid arthritis is characterized by joint swelling, pink rash over the trunk and may also affect the heart, spleen, liver and can also show enlarged lymph nodes.
These patients are negative for both ANA and rheumatoid factor(RA factor).
A small fraction of these patients can develop severe arthritis that can continue into adulthood.

When to consult a doctor

If a child has joint stiffness, pain, and swelling for over a week with a high-grade fever.

Whom to consult (JRA specialist)

A rheumatologist is a doctor that holds a degree in rheumatology, a branch of medicine that deals with such diseases.

Diagnosis

The diagnosis of is Juvenile rheumatoid arthritis is mainly clinically based on the clinical examination by rheumatologist but, there are few tests that can be used to confirm the diagnosis.
These tests can also be used to differentiate between different types of Juvenile rheumatoid arthritis.

A) Rheumatoid factor test:

Rheumatoid factor is an antibody.
This test detects the presence of this antibody in the patient's blood.
The positive test suggests the polyarticular type of Juvenile rheumatoid arthritis. 
A small fraction of patients show positive tests as polyarticular arthritis is the least common variety of Juvenile rheumatoid arthritis.

B) ANA test:

ANA is an antibody protein created by the immune system of patients with autoimmune disorders.
Children showing symptoms of Juvenile rheumatoid arthritis most likely suggest pauciarticular type.

C) HLA-B27 test:

This test detects the hereditary antibodies for Juvenile rheumatoid arthritis.

Treatment of JRA

Early diagnosis and prompt treatment can effectively manage the effects of Juvenile rheumatoid arthritis.
A combination of treatments is suggested to relieve pain and swelling.

A) Medical treatment:
   Drugs used in the treatment of Juvenile rheumatoid arthritis are-

1) Nonsteroidal anti-inflammatory drugs(NSAIDs)  such as ibuprofen and naproxen.

2) Aspirin might be recommended if over-the-counter drugs aren't effective. But aspirin is rarely recommended due to its adverse side effects.

3) Other cytotoxic drugs like rituximab and etanercept are also used in treatment.

In severe cases where medical treatment fails surgery may be done to replace the joint.

B) Physical therapy:

Physical therapy can help build strength and restore flexibility in stiff joints.
A physiotherapist can teach your child the exercises specific to their condition.

Complications of JRA

Serious complications of Juvenile rheumatoid arthritis are uncommon but they can occur if the disease is not diagnosed early and treated promptly.
By keeping a careful watch on the child's condition and seeking appropriate medical attention following complications can be avoided.

A) Growth of a child:

Juvenile rheumatoid arthritis interferes with the child's development, especially bone development.
Medications used for treatment should be used carefully as corticosteroids used for treatment can interfere with the growth of a child.

B)Eyes:

Inflammation of the eyes is a common complication of Juvenile rheumatoid arthritis. It occurs without any signs and symptoms.
If left untreated can result in glaucoma, cataract or even blindness.

JRA prognosis

With early diagnosis and prompt treatment, the effects of Juvenile rheumatoid arthritis can be minimized and the disease can be treated early so, it doesn't continue into adulthood.

Differences between JRA and adult rheumatoid arthritis

1) JRA disappears in 60-70% of children until adulthood. while adult rheumatoid arthritis has lifelong symptoms.

2) RA factor positivity: 70-80% of cases of adult rheumatoid arthritis have RA factor (positive test), while only 20-30% of cases of Juvenile rheumatoid arthritis give positive RA factor test.



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