17. Rheumatology Flashcards
1
Q
Describe epidemiology: Growing pains (2)
A
- age 2 - 12yr
- M=F
2
Q
Name clinical features: Growing pains (6)
A
- diagnosis of exclusion
- intermittent, non articular pain in childhood. with normal physical exam findings
- pain at night, often bilateral and limited to the calf, shin, or thigh; typically short-lived
- relieved by heat, massage, mild analgesics
- child is well, asymptomatic during the day, no functional limitation
- possible family history of growing pains
3
Q
Describe: Juvenile Idiopathic Arthritis (6)
A
- a heterogenous group of conditions characterized by persistent arthritis in children < 16yr
- diagnosis: arthritis in ≥ 1 joint(s);
- duration ≥6wk;
- on set age <16 yr old;
- exclusion of other causes of arthritis;
- classification defined by features/number of joints affected in the first 6 mo of onset
4
Q
Name types of Juvenile Idiopathic Arthritis (5)
A
- Systemic Arthritis (Still’s Disease)
- Oligoarticular Arthritis (1-4 joints)
- Polyarticular Arthritis (5 or more joints)
- Enthesitis-Related Arthritis
- Psoriatic Arthritis
5
Q
Describe: Systemic Arthritis (Still’s Disease) (5)
A
- on set at any age,M=F
- once or twice daily fever spikes (>38.5oC) ≥ 2d/wk with temperature returning below baseline;children usually acutely unwell during fever episodes
- extra-articularfeatures: erythematous “salmon-coloured” maculopapular rash, lymphadenopathy, hepatosplenomegaly, leukocytosis, thrombocytosis, anemia, serositis
- arthritis may occur weeks to months later
- high ESR,CRP, WBC,platelet count
6
Q
Name most common type of juvenile idiopathic arthritis (1)
A
Oligoarticular Arthritis (1-4 joints)
7
Q
Describe: Oligoarticular Arthritis (1-4 joints) (7)
A
- onset early childhood (<5 years of age), F>M
- persistent: affects no more than 4 joints during the disease course
- extended: affects more than 4 joints after the first 6 mo
- typically affects large joints: knee most common, elbows, wrists; hip involvement unusual
- ANA positive~60-80%, RF negative
- screening eye exams for asymptomatic anterior uveitis (occursin~30%)
- complications: knee flexion contracture, quadriceps atrophy,leg-length discrepancy,growth disturbances, uveitis
8
Q
Describe: Polyarticular Arthritis (5 or more joints) (3)
A
- ANA positive in 50%
- uveitis in 10%
- RF negative (usually) or positive
9
Q
Describe: Polyarticular Arthritis RF negative (2)
A
- onset: 2-4 yr and 6-12 yr, F>M
- symmetrical involvement of large and small joints of hands and feet, TMJ, cervical spine
10
Q
Describe: Polyarticular Arthritis RF positive (5)
A
- onset: late childhood/early adolescence, F>M
- similar to the aggressive form of adult rheumatoid arthritis
- severe, rapidly destructive, symmetrical arthritis of large and small joints
- may have rheumatoid nodules at pressure points (elbows, knees)
- unremitting disease, persists into adulthood
11
Q
Describe: Enthesitis-Related Arthritis (5)
A
- onset: late childhood/adolescence, M>F
- arthritis and/or enthesitis (inflammation at the site where tendons or ligaments attach to the bone)
- weight bearing joints, especially hip and intertarsal joints
- risk of developing ankylosing spondylitis in adulthood
- asymmetric involvement of lower limb joints, associated with HLA-B27 and development of symptomatic uveitis/ iritis
12
Q
Describe: Psoriatic Arthritis (3)
A
- onset :2-4yr and 9-11yr, F>M
- arthritis and psoriasis OR arthritis and at least two of:
- dactylitis, nail pitting or other abnormalities, or family history of psoriasis in a 1st degree relative
- asymmetric or symmetric small or large joint involvement
- erythematous, scaly lesions on scalp, post-auricular area,peri-umbilicus or over extensor surfaces of elbows and knees
13
Q
Describe management: Juvenile Idiopathic Arthritis (5)
A
- goals of therapy: eliminate inflammation, prevent joint damage, promote normal growth and development as well as normal function, minimize medication toxicity
- exercise (moderate, fitness, flexibility and strengthening exercises) to maintain ROM and muscle strength
- multidisciplinary approach: OT/PT, social work, orthopedics, ophthalmology, rheumatology
- 1st line drug therapy: NSAIDs, intra-articular corticosteroids
- 2nd line drug therapy: DMARDs (methotrexate, sulfasalazine, leflunamide), corticosteroids (acute management of severe arthritis, systemic symptoms of JIA, topical eye drops for uveitis), biologic agents (IL1, IL6 inhibition for systemic arthritis, TNF antagonist for polyarticular JIA
14
Q
A
15
Q
Name: Red Flags for Limb Pain (8)
A
- Fever
- Pinpoint pain/tenderness
- Pain outofproportiontodegreeof
- inflammation
- Night pain
- Weight loss
- Erythema
- Unexplained fractures