CH 29 Rheumatic Diseases Flashcards
Juvenile Idiopathic Arthritis (JIA)
chronic arthritis in one or more joints for at least 6 weeks. cause is unknown but thought to be autoimmune
oligoarticular JIA signs and symptoms
most common type and is characterized by 4 or fewer medium to large joints. usually asymmetrical and may develop leg length discrepancy due to increased blood flow and growth factors. synovitis mild and may be painless, insidious, and may cause blindness if untreated. if ANA is positive, do eye tests at 3 month intervals
polyarticular JIA
involves 5 or more joints. typically symmetrical. may have low grade fever, fatigue, rheumatoid nodules, and anemia and resembles adult rheumatoid arthritis
systemic JIA or still disease
affects 5-10% of patients. can affect many joints both large and small. high fever (39-40 C), occurring once or twice a day, evanescent salmon pink macular rash most prominent on pressure areas
enthesitis associated JIA
most common in males, older than 10 years old, associated with lower extremity large joint arthritis. Hallmark: inflammation of tendinous insertions (enthesopathy), such as tibial tubercle or the heel. Low back pain and sacroiliitis
JIA lab findings
no diagnostic test. normal ESR doesnt exclude JIA. elevated markers of inflammation like ESR, c reactive protein, WBC, and platelets. RF is positive in 5% of patients. anti CCP has high specificity for RA.
JIA imaging
soft tissue swelling and periarticular osteoporosis seen in early stages. MRI may show early joint damage and synovitis. US best diagnostic now. Later in disease, xray is best to show joint space narrowing.
JIA treatment
NSAIDs (first line therapy, ibuprofen, naproxen, meloxicam with improvement in 4-12 weeks), Disease modifying and biologic agents (weekly methotrexate, check CBC and LFTs; leflunomide, etanercept, infliximad and adalimumab, anakinra and tocilizumab), Corticosteroids (injections, tramcinolone hexacetonide), uveitis (inflammation of uveal tract, treated with corticosteroid eye drops and dilating agents), rehab
SLE
antibody antigen complexes exist in circulation and deposit in involved tissues.
SLE signs and symptoms
most common in girls 9-15. Signs depend on organs affected. Malar rash-photosensitive (butterfly rash on cheeks and nasal bridge), discoid rash (annular scaly rash on scalp, face, and extremities, photosensitivity, mucous membrane ulcers, arthritis, serositis (pericarditis and/or pleuritis), renal abnormalities (proteinuria and cellular casts), neuro abnormalities (seizures), blood count abnormalities (low WBC, positive coombs test, anemia, thrombocytopenia), positive ANA, Autoantibodies (positive double stranded DNA, anti smith antibody, lupus anticoagulant, false positive syphilis test)
SLE treatment
Prednisone, IV methylprednisone, NSAIDs, steroid sparing agent (mycophenolate mofetil, azathioprine, or cyclophosphamide), baby aspirin (need long term anticoagulant. Look out for infections from steroid, bone marrow suppression, bladder dysplasia, hemorrhagic cystitis and sterility
