Atopic, Rheumatic, and Immunodeficiency Disorders

Question 1

Types of JIA

Answer 1

1. Oligoarticular pattern
2. Polyarticular pattern
3. Systemic JIA
4. Enthesitis-related JIA
5. Psoriatic arthritis

Question 2

Oligoarticular pattern

Answer 2

• 4 or less weight bearing joints
• larger joints
• systemic symptoms

Question 3

Polyarticular pattern

Answer 3

• 5 or more joints
• RF neg or RF pos
• large or small joints
• RF pos - chronic symmetric joint swelling

Question 4

Systemic JIA

Answer 4

• arthritis for more than 6 weeks with a fever for 2 weeks duration with 3 days in a row
• fleeting rash, hepatomegaly, splenomegaly, cardiac issues
• RF rarely pos/ANA pos in 5-10%
• 10% develop macrophage activation syndrome (MAS)

Question 5

Enthesitis-related JIA

Answer 5

• arthritis in lower limbs
• risk of ankylosing spondylitis in 10-15 years
• occurs in late childhood/adolescence

Question 6

Psoriatic arthritis

Answer 6

• more common in ages 2-4 and then 9-11 years
• family hx of psoriasis
• dactylitis or sausage-like swelling of digit

Question 7

Diagnostic Tests for JIA

Answer 7

• no one test, must rule out other diseases

Question 8

Management of JIA

Answer 8

• refer to ophthalmologist
• refer to pediatric rheumatology
• NSAIDs (ibuprofen, tolmetin, naproxen, indomethacin, celecoxib)
• corticosteroids
• DMARDs (methotrexate, “-mabs”)

Question 9

Clinical Findings of Lupus

Answer 9

• butterfly or malar rash
• other findings depend on organ involvement
• abrupt or gradual onset
• fever, rash, fatigue, joint pain typical in children
• gingivitis
• cardiac friction rub
• pleural friction rub
• joint tenderness

Question 10

Diagnostic Studies for SLE

Answer 10

• CBC, ANA, ESR, CRP, metabolic screen, UA
  **ANA is positive in 97% cases
• antibody screen
• EKG, renal U/S

Question 11

Management of SLE

Answer 11

• referral to rheumatologist
• avoid sun; use sunscreen
• NSAIDs
• steroids
• antimalarials
• immunosuppressants (methotraxate)
• monoclonal antibodies
• vitamin D/calcium

Question 12

Atopic Dematitis

Answer 12

• the itch that rashes
• seen a lot in folds of skin
• inability of skin to hold in moisture
• lichenification, cracking
• worse in winter

Question 13

Diagnostic Studies for Atopic Dermatitis

Answer 13

none needed; based on characteristic findings

Question 14

Management of Atopic Dermatitis

Answer 14

• no itching
• no harsh soaps
• rehydrate skin
• topical corticosteroids
• wet wrap therapy
• antihistamines at night
• eliminate allergens