B6-006 CBCL Juvenille Idiopathic Arthritis Flashcards
-common elbow injury in children <5 caused by a sudden pull on the arm.
-causes the immature annular ligament to slip over the head of radius
radial head subluxation (nursemaid’s elbow)
child holding their injured arm in slightly flexed and pronated position
radial head subluxation (nursemaid’s elbow)
overuse injury caused by repetitive strain and chronic avulsion of the proximal tibial tubercle
Osgood-Schlatter disease
-commonly occurs in adolescents following growth spurt or running/jumping athletes
-presents with progressive anterior knee pain
Osgood-Schlatter disease
-overuse injury that commonly presents in young, female athletes as anterior knee pain
-exacerbated by prolonged sitting or kneeling
patellofemoral syndrome
abnormal acetabulum development in newborns
developmental dysplasia of the hip
risk factor for developmental dysplasia of the hip
breech presentation
manipulation of newborn hip reveals “clunk”
developmental dysplasia of the hip
a diagnosis of developmental dysplasia of the hip can be confirmed via what imaging modality?
US
idiopathic avascular necrosis of the femoral head
Legg-Calve-Perthes
commonly presents between 5-7 years with insidious onset of hip pain that may cause the child to limp
Legg-Calve-Perthes
Legg-Calve-Perthes is more common in [males/females] and the intial Xray is often [normal/abnorma]
males
normal
classically presents in an obese young adolescent with hip/knee pain and altered gait
slipped capital femoral epiphysis
increased axial force on the femoral head causes epiphysis to displace relative to femoral neck
slipped capital femoral epiphysis
**ice cream falling off cone
slipped capital femoral epiphysis is diagnosed via what imaging modality?
Xray
systemic arthritis seen in <16 years of age
systemic juvenile idiopathic arthritis
daily spiking fevers, salmon-pink macular rash, arthritis
systemic juvenile idiopathic arthritis
systemic juvenile idiopathic arthritis is associated with what pathology of the eye?
uveitis
expected labs for systemic juvenile idiopathic arthritis
leukocytosis
thrombocytosis
anemia
elevated ESR
elevated CRP
disruption of blood flow to the femoral head
Legg-Calves-Perthes
congenital malformation of the acetabulum
developmental hip dysplasia
displacement of the epiphysis relative to the femoral head
slipped capital femoral epiphysis
dysregulation of the adaptive immune system
JIA
bone fragmentation at the tibial tuberosity
Osgood Schlatter
chrondrocalcinosis is associated with
pseudogout
next step in management of slipped capital femoral epiphysis
surgical evaluation
splint can be used in some case of
development hip dysplasia
[…] is an important management strategy for patellofemoral pain
quadriceps strengthening
next best step for JIA that is unresponsive to naproxen and only involves a single joint
intra articular steroid injection
best treatment of oligoarticular JIA with systemic symptoms
methotrexate
what medication can cause osteoporosis and be associated with fragility fractures?
prednisone
common side effect of methotrexate
oral ulcers
common side effect of anakinra
injection site reactions
individuals with JIA are at high risk for […] and require consistent monitoring as it can present asymptomatically
uveitis
immature annular ligament slipping over radial head
radial head subluxation
treatment for radial head subluxation
manual reduction
MOA: inhibition of dyhydrofolate reductase
methotrexate
besides age, what can be helpful in distinguishing JIA from adult onset RA?
pattern of joint involvement
most children with systemic JIA will require persistent use of […] to achieve remission
immunomodulatory therapy
risk of uveitis is [higher or lower] in soJIA than other types of JIA
lower
what percentage of patients with soJIA develop MAS?
10%
immune dysregulation associated with infections or oncologic process
HLH
**the term MAS is reserved for patients with underlying rheumatologic disease
[…] should prompt consideration that a patient with soJIA is progressing to MAS
hepatic dysfunction
fever, rash, arthritis, and evidence of multiorgan dysfunction
MAS
approximately 20% of MAS in soJIA occurs at time of
initial diagnosis
first-line treatment for MAS
pulse dosing IV steroids
MIS-C is associated with thrombo[…]
thrombocytopenia
KD is associated with thrombo[..]
thrombocytosis
used in refractory Kawasaki disease
inflixumab
second-line treatment for MAS or MIS-C
anakinra
what type of arthritis is associated with IL-1?
soJIA
what type of arthritis is associated with TNFa?
oligoarticular and polyarticular JIA
what type of arthritis is associated with IL-17?
psoriatic and ankylosing spondylitis
1-4 joints impacted
oligoarticular
JIA typically presents with […] involvement, while RA typically presents with […] involvement
JIA: oligoarticular
RA: polyarticular
[…] can be seen in MAS due to the significant consumptive process and bone marrow involvement
thrombocytopenia
Legg-Calve-perthes typically affects children in the age range of […]
5-7
methotrexate can be used to treat [….]JIA
polyarticular JIA
anakinra can be used to treat […] JIA
soJIA
tenderness of the patella tendon
Osgood-Schlatter
discomfort with patellar grind
patellofemoral syndrome
hyperglycemia can be associated with what medication?
prednisone
