Arthritis Flashcards
What is septic arthritis?
It is a serious infection of the joint space which can lead to bone destruction.
Most commonly occurs in boys under 2
What are the common causative organisms for septic arthritis?
Staph aureus and HIB unvaccinated.
In neonates may also be caused by: E.coli and Group B strep.
Should also consider Tb (more likely to effect the spine).
Often spreads via the blood but may come from adjacent osteomyelitis.
How does septic arthritis present?
In an acutely unwell febrile child:
- Erythematous, warm, swollen tender joint (usually only 1)
- Reduced range of movement
How should septic arthritis be investigated and managed?
Normal blood tests for severe infection.
Aspiration of the joint space under ultrasound guidance for organisms and culture is the definitive diagnosis.
Long course of IV antibiotics with washout of the infected joint.
How does septic arthritis of the hip present?
Septic arthritis of the hip can be particularly difficult to diagnose in toddlers as the joint is well covered by subcutanoues fat.
Initial presentation may be with a limp or pain referred to the knee.
What is juvenile idiopathic arthritis?
It is defined as persistent joint swelling (of greater than 6 weeks duration) presenting before 16 years of age and in the absence of infection or any other defined cause.
Incidence 1 in 1000
How is juvenile idiopathic arthritis classified?
Depending on the number of limbs affected:
Monoarthiritis = 1 joint Oligoarthiritis = less than 4 Polysrthiritis = more than 4
How does juvenile idiopathic arthritis present?
Joint swelling Stiffness after periods of rest Morning joint stiffness Pain Contractures
May also have uveitis therefore always important to refer to ophthalmology
How is juvenile idiopathic arthritis managed?
NSAIDs often used for pain relief
For oligoarthiritis:
-Joint steroid injections in children often need to be doe under anaesthetic.
For polyarthitis:
-Methotrexate is usually successful and reduces joint damage.
Systemic corticosteroids can be used but are avoided due to s/e’s of growth suppression and osteoporosis as both can occur in juvenile idiopathic arthiritis.
Immune Modulators:
-Can be used as a last line and can be successful but wide s/e profile and very expensive
What is reactive arthritis?
It is the most common form of childhood arthritis and is characterised by transient joint swelling lasting less tan 6 weeks.
What causes reactive arthritis?
It is usually caused as a post infective complication of a:
- GI infection
- STI infections
- Viral (mononucleosis, mycoplasma)
Rarely it can be caused as a post strep complication.
What is the treatment of reactive arthritis?
It is self limiting and treatment is with:
- analgesia
- rest of affected joint
After recovery there can be some physio to rebuild the affected muscle groups.
