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3rd Year - Paediatrics > 15. Paediatric Rheumatology > Flashcards

15. Paediatric Rheumatology Flashcards

1
Q

What are the Benign Symptoms of Paediatric Rheumatology?

A
  1. Worse with Activity / Better with Rest
  2. Worse at the end of the day
  3. If night pain is relieved with simple Analgesia
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2
Q

What are the Benign Signs of Paediatric Rheumatology?

A
  1. No Joint Swelling
  2. No Bony Tenderness
  3. Normal Strength
  4. Normal Height / Weight Growth
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3
Q

What are the Red Flag Symptoms of Paediatric Rheumatology, suggestive of a Serious Condition?

A
  1. Fever
  2. Malaise / Lethargy
  3. Morning Joint Stiffness / Pain
  4. Night Pain Refractory to Simple Analgesia and Symptomatic during the Daytime
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4
Q

What are the Red Flag Signs of Paediatric Rheumatology, suggestive of a Serious Condition?

A
  1. Joint Swelling
  2. Bony Tenderness to Palpation
  3. Muscle Weakness
  4. Fall in Height / Weight Growth Curve
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5
Q

What are the Blood Investigation Findings associated with Paediatric Rheumatology Disease?

A
  1. Raised White Blood Cells and Neutrophils
  2. ESR Elevated - 48 hours after the Inflammation
  3. CRP Elevated - 6 hours after the Inflammation
  4. Blood Film - Normal Film does not Exclude Malignancy
  5. Blood Cultures - 46-80% Osteomyelitis
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6
Q

What are the Investigation Findings associated with Paediatric Rheumatology Disease?

A
  1. Plain X-Ray - May be normal early
  2. Ultrasound - Sensitive in detecting Joint Effusions
  3. MRI - Sensitive in detecting Early Osteomyelitis / Perthe’s / Inflammatory Disease / Malignancy
  4. Bone Scan - Sensitive in detecting Early Osteomyelitis
  5. CT - Useful to Detect Early Bone Changes / Tumours
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7
Q

What is the Epidemiology of Juvenile Idiopathic Arthritis?

A
  1. Female>Male - 3:1
  2. Aetiology is Unknown
  3. Chronic Inflammation
  4. Activated T-Cells and Macrophages involved
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8
Q

What are the Different Classifications of Juvenile Idiopathic Arthritis?

A
  1. Oligoarticular Juvenile Idiopathic Arthritis - 1-4 Joints:
  2. a) Persistent
  3. b) Extended - More than 4 Joints after 6 Months
  4. Polyarthritis - 5+ Joints in the first 6 Months:
  5. a) Rheumatoid Factor Negative
  6. b) Rheumatoid Factor Positive
  7. Psoriatic Arthritis
  8. Systemic Onset Arthritis
  9. Enthesitis Related Arthritis
  10. Undifferentiated
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9
Q

How does Juvenile Idiopathic Arthritis present?

A
  1. Joint Pain / Swelling
  2. Stiffness - Early Morning / Relieved by Movement
  3. Abnormal Gait / Movements / Posture / Limp
  4. Babies / Infants Crying / Irritability
  5. Regression of Milestones in Infants
  6. Fever / Rash
  7. Lymphadenopathy
  8. Hepatomegaly / Splenomegaly
  9. Serositis
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10
Q

What is the Medical Differential Diagnosis for Juvenile Idiopathic Arthritis?

A
  1. Septic Arthritis
  2. Reactive Arthritis
  3. Rheumatic Fever
  4. Associated with Inflammatory Bowel Disease
  5. Connective Tissue Disorder - SLE / Hypermobility / Growing Pain
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11
Q

What is the Surgical Differential Diagnosis for Juvenile Idiopathic Arthritis?

A
  1. Perthe’s Disease
  2. Slipped Upper Femoral Epiphysis
  3. Congenital Hip Dysplasia
  4. Fracture
  5. Trauma
  6. Referred Pain
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12
Q

What is the Malignant Differential Diagnosis for Juvenile Idiopathic Arthritis?

A
  1. Leukaemia
  2. Neuroblastoma
  3. Primary Bone Tumour
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13
Q

What are the investigations for Juvenile Idiopathic Arthritis?

A
  1. Anti-Nuclear Antibodies (ANA)
  2. HLA-B27
  3. Inflammatory Markers
  4. Rheumatoid Factor
  5. X-Ray / MRI
  6. MSK Examination of All Joints - not just symptomatic
    Note - No Specific Test and Results are often Normal / Negative. This is to Exclude a Differential Diagnosis
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14
Q

What is the Management of Juvenile Idiopathic Arthritis?

A
  1. Encourage Normal Activity
  2. Drug Treatment
  3. Regular Ophthalmology Review for Uveitis
  4. Physiotherapy - Including Hydrotherapy
  5. Occupational Therapy
  6. Psychology
    Note - Do Not Advise Rest / Splints / Crutches …
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15
Q

What is the Drug Treatment of Juvenile Idiopathic Arthritis?

A
  1. NSAID’s
  2. Intraarticular Joint Steroid Injection
  3. Oral / I.V. Methylprednisolone - Systemically
  4. DMARD - Methotrexate / Biologics
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16
Q

What are the Poor Prognosis Factors for Juvenile Idiopathic Arthritis?

A
  1. Active Disease at 6 Months
  2. Polyarticular Onset and Course
  3. Extended Oligoarticular
  4. Female
  5. Rheumatoid Factor Positive
  6. ANA Positive
  7. Persistent Raised Inflammatory Markers
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17
Q

What are the Complications of Juvenile Idiopathic Arthritis?

A
  1. Altered Growth of Limbs
  2. Scoliosis
  3. Short Stature
  4. Joint Damage / Destruction
  5. Blindness - Untreated Uveitis
  6. Psychological Effects of Chronic Disease
  7. Loss of Schooling
18
Q

What are the Features of Septic Arthritis / Osteomyelitis?

A
  1. Fever
  2. Systemic Upset
  3. Severe Limitation of Joint Movement
    Note - Beware of Subtle Presentation
19
Q

What Investigations should be done for Septic Arthritis / Osteomyelitis?

A
  1. Bloods - FBC / CRP / ESR
  2. Ultrasound Guided Joint Aspiration
  3. X-Ray may show signs of Osteomyelitis
20
Q

What is the Management of Septic Arthritis / Osteomyelitis?

A
  1. Urgent Orthopaedic Input

2. May need Washout and I.V. Antibiotics

21
Q

What are the Features of Trauma?

A
  1. History of Trauma

2. Signs of Injury

22
Q

What Investigations should be done for Trauma?

A

X-Ray / CT Scan

23
Q

What is the Management of Trauma?

A
  1. Inpatient / Outpatient

2. Management is dependent on the Type / Cause of the Injury

24
Q

What are the Features of Irritable Hip?

A

Systemically Well

25
Q

What Investigations should be done for Irritable Hip?

A

Bloods - FBC / CRP / ESR

26
Q

What is the Management of Irritable Hip?

A
  1. Advise Regular Analgesia for 48 hours

2. Review in 7-10 days

27
Q

What are the Features of Henoch-Schoenlein Purpura?

A
  1. Purpuric Rash
  2. Abdominal Pain
  3. Haematuria
28
Q

What Investigations should be done for Henoch-Schoelein Purpura?

A
  1. Urine Dipstick and Microscopy

2. Blood Pressure

29
Q

What is the Management of Henon-Schoelein Purpura?

A

Paediatric Referral and Follow Up

30
Q

What are the Features of Haemarthrosis?

A

If Spontaneous / After Minor Injury consider Haemophilia

31
Q

What Investigations should be done for Haemarthrosis?

A

Coagulation Studies

32
Q

What is the Management of Haemarthrosis?

A

Paediatric Referral if Clotting Screen Normal

33
Q

What are the Features of Rheumatic Fever?

A
  1. Carditis
  2. Erythema Marginatum
  3. Migrating Polyarthritis
  4. Subcutaneous Nodules
  5. Chorea
34
Q

What Investigations should be done for Rheumatic Fever?

A
  1. ECG / Echo
  2. Bloods - FBC / CRP / ESR / U&E
  3. ASOT (Antistreptolysin O Titer)
  4. DNase B (Looking for Group A Strep Antibodies)
35
Q

What is the Management of Rheumatic Fever?

A

Refer to Paediatrics

36
Q

What are the Features of Serum Sickness?

A
  1. History of Medication use

2. Rash

37
Q

What Investigations should be done for Serum Sickness?

A
  1. Bloods - FBC / CRP / ESR / U&E
  2. ASOT (Antistreptolysin O Titer)
  3. DNase B (Looking for Group A Strep Antibodies)
38
Q

What is the Management of Serum Sickness?

A

Follow up in 7-10 days

39
Q

What are the Features of Reactive Arthritis?

A
  1. History of Recent Viral illness

2. Well Child

40
Q

What Investigations should be done for Reactive Arthritis?

A

Exclude Septic Arthritis

41
Q

What is the Management of Reactive Arthritis?

A

Follow up in 7-10 days

3rd Year - Paediatrics (40 decks)

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