idiopathic arthritides of childhood Flashcards
What are the classes of idiopathic arthritides of childhood?
systemic arthritis, polyarthritis (rheumatoid factor positive and negative), oligoarthritis and extended oligoarthritis, enthesititis related arthritis, and psoriatic arthritis
What are the definite characteristics of systemic arthritis?
documented quotidian fever (daily) for at least 2 wks
evanescent, nonfixed, erythematous rash, and arthritis (may present last). rash is most likely to be present when the kid has a fever and may appear after you scratch or abrade the skin
fever must be above 39 degrees during spikes and at or below 37 in troughs
What are some features of systemic arthritis that are considered probable (ie. you see fever and rash but no arthritis- what other symptoms would suggest systemic arthritis)?
generalized LAD, hepato/splenomegaly, or serositis
LAD may be quite PROMINENT
systemic arthritis: age, ANA, RF
age under 16, negative ANA and negative RF
complications of systemic arthritis
permanent joint degeneration, macrophage activation syndrome (where the macrophage has phagocytized RBCs. seen in 15% of kids with systemic arthritis and has 30% mortality rate. Kid will get sicker with liver and renal dysfunction, while ESR returns to close to normal (from liver dysfunction)
features of polyarthritis rhematoid factor negative disease: number of joints and time course, age, symmetry, ANA other features
arthritis of 5 or more joints in the first 6 months of the disease
kid is under 16
arthritis may be symmetric or asymmetric but DIPs are usually spared. you may see atrophy of interosseous musculature
ANA almost always negative
uveitis is very rare
Some important features of management of polyathritis rheumatoid negative disease
pharm treatments not discussed, but remember that you often need physical therapy or occupational therapy with splinting, esp. during sleep
complications of polyarthritis rheumatoid negative disease
loss of cervical curvature and fusion of the cervical spine. child won’t be able to look up.
she also has a very small jaw (micrognathia), growth retardation, swollen and contracted joints
many of the complications can be prevented with modern treatments
features of polyarthritis rheumatoid factor positive: age at onset, pattern of arthritis, number of joints, ANA
arthritis in 5 or more joints in the first 6 months of disease
associated with positive RF on 2 occasions 12 wks apart
age under 16
may be symmetric or asymmetric (less commonly)
ANA is positive in 50%
kid can’t have psoriasis or family hx of psoriasis
very rare
other features of RF polyarthritis in a child
may have rheumatoid nodules on extensor surfaces
oligoarthritis features: number of joints, ages, pattern, ANA, other features
1-4 joints affected in a kid under 16
pattern may be anything, but usually affects the large joints
ANA can be present in 30-40% of cases
uveitis is a bad complication (oligoarthritis is the one most likely to have an extra-articular manifestation.
complications of oligoarthritis
uveitis: may be gradual indolent process. but harder to diagnose once advanced. ANA positivity is a risk factor for uveitis- if present, you must screen with slit lamp exam every 3 mo for the first 5 yr of disease. if advanced, you will see irregular pupil and synechiae or calcium deposits in the eye
also, the affected joint may be hyperperfused, causing excess activation of the growth plate. affected leg will be longer
extended arthritis
affects 1-4 joints in the first 6 mo, and a cumulative total of 5 or more jts after the first 6 mo
what is enthesitis related arthritis?
sacroiliac joint tenderness with inflammatory spinal pain
HLA-B27 factors
anterior uveitis associated with pain, redness, or photophobia
psoriatic arthritis in a kid
arthtritis and psoriasis or arthritis and a positive fam hx of psoriasis in parent or sibling, plus dactylitis or nail abnormalities like pitting or onycholysis
usually symmetric
