27. Rheumatology Flashcards
How does septic athritis present?
Acute onset fever Joint pain and swelling Unwell appearance Irritable Tachycardia Joint effusions Periarticular warmth and tenderness Pain on movement
What will you see when yiu investigate a childhood JIA?
Elevated CRPand ESR- markedly raised
Raised white cell and platelets
Blood cultures results- typically negative
Ultrasound d helpful to see effusions
How do you manage a child with septic athritis?
Empiral intravenous antibiotics
Joint aspiration
Refer to orthopaedics
What is SUFE?
Slipped upper femoral epiphysis
Displacement of the capital femoral epiphysis
Most common hip disorder of the adolescence
Associated with obesity
Pain and altered gait
Worse and activity
How does transient synovitis present?
Pain and limited movement in the hip Relatively common Etiology unclear 3-8 years age group Symptoms <1 week Fever absent or low grade Not unwell looking Us bilateral effusion Resolves gradually with conservative therapy
What is perthes?
Idiopathic avascular necrosis of the hip
Resents as insidious hip pain and limo Pain not relieved by rest or medication 3-12 years peak 5-7 years Bilateral 10-20% M:F 3-4:1 Etiology undefined
How do you manage perthes?
Refer to ortho
Minimal weight bearing
May use splints to contain the head of the acetabulum with the use of splints
Occasional surgery
What should you watch out for with the acute limping child
Non accidental injury (abuse)
Malignancy- waking up and unresolved crying at night
What is juvenile idiopathic athritis
Most common chronic rheumatologic disease in children
Immune response with pro-inflammatory markers
Presentation on antibodies
What are the symptoms of JIA
Athritis of at least 6 weeks (more long term than others) Morning stiffness or telling Refusal to walk in toddlers School absence or limited physical activity participation Rash/fever Fatigue Poor appetite and weight loss Delayed puberty
What are the different types of JIA?
Oligo athritis- less than 5 joints
Polyarthritis (RF+ve)- poor prognosis - RA
Polyarthritis (RF-ve)
Enthesitis related arthritis- tendons over muscles
Psoriatic athritis- related to psoriasis
Systemic onset- Stills disease
What do you look for in JIA?
Swelling Tenosynovitis- (swollen tendons) Pain Joint held joint of maximum comfort (joint will get stuck unless treated) Range of motion limited at extremities
What is the takeaway in this lecture
Septic athritis- BIG RED HOT ANGRY JOINT (typically one joint)
JIA- swelling, maybe slightly red (almost always multiple joint for weeks and weeks)
What are the symptoms of systemic JIA?
Unwell Athritis Intermittent fevers> 2 weeks (fever very intermittent, different to septic) Salmon pink erythematous rash Generalised lymphadenopathy Serostis - inflammation of serosal tissues (heart) Hepatomegaly/splenomegaly High inflammatory marker
How do you investigate JIA?
Labs
Plain X-Ray
USS
MRI with contrast
What occurs in inflammatory markers in JIA vs septic athritis
JIA only one is raised- maybe ESR?
Septic athritis- both are severely
What are the phramacological treatments of JIA?
NSAIDS- short term
DMARDS- disease modifying
Biologics
What other treatments are their for JIA?
Physio
Nutrition
Return to school
Occupational therapy
What are intraarticular steroids?
Steroids injected into the joint Good treatment Greater success in oligoarticular athritis Safe and effective noo long term side effects
Discuss DMARDS?
Methotrexate- very common
Poor response to intraarticular steroids in oligo JIA
Give early for good outcome
What are the biological agents used?
Anti TNF therapy
Good safety profile
Newer biologics
What is one of the major complications of JIA
Uveitis! Swelling of the uvela
How do you treat uveitis in JIA?
Treat! Can be unsymptomatic Undergo screening More common in ANA over JIA Symptoms include red eyes,headaches, reduced vision, glaucoma and blindness
How do you treat uveitis?
Need slit lamp investigation
Topical steroids to reduce inflammation
More severe need systemic steroids
DMARD and biologics
What are the complications of JIA?
Poor growth Osteopenia- bony erosions Localised growth disturbance Micrognathia Contracture Ocular complications
