ILAs Flashcards
Management of juvenile infant arthritis?
-NSAIDs, such as ibuprofen
-Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
-DMARDs- methotrexate, sulfasalazine and leflunomide
-Biologics -TNF inhibitors etanercept, infliximab and adalimumab
What is still disease
-a subtype of Juvenile idiopathic arthritis
-which is systemic and can affect joints and organs
Signs of stills disease (systemic arthritis) (8)
-Subtle salmon-pink rash
-High swinging fevers
-Enlarged lymph nodes
-Weight loss
-Joint inflammation and pain
-Splenomegaly
-Muscle pain
-Pleuritis and pericarditis
Complication of Systemic JIA?
-macrophage activation syndrome
What is macrophage activation syndrome?
-severe activation of the immune system and inflammatory response
Investigation that will suggest Macrophage activation syndrome?
Low ESR
Key NON INFECTIVE differentials of a high grade fever for 5+ days? (4)
-Kawasaki disease
-stills’s disease
-rheumatic fever
-leukemia
5 Subtypes of JIA?
-Systemic JIA
-Polyarticular JIA
-Oligoarticular JIA
-Enthesitis related arthritis
-Juvenile psoriatic arthritis
Macrophage activation syndrome presentation
-stills disease presentation
PLUS
-aneamia
-DIC
-thrombocytopenia
-non blanching rash
What is polyarticular arthritis?
-Idiopathic inflammatory arthritis in 5 joints or more
-tends tot be symmetrical
What is oligoarticular JIA?
- idiopathic inflammatory arthritis, involving 4 joints or less
-tends to affect larger joints like hips and knees
What presentation is commonly associated with Oligoarticular JIA?
Anterior uveitis
Which group are the sites related arthritis more common in
Males over 6 years
- equivalent to seronegative spondyloarthropathies such as Ankylosing spondylitis, psoriatic arthritis and reactive arthritis
What is an enthesis?
Point at which the tendon of a muscle inserts into a bone
What is Enthesitis-Related Arthritis?
Inflammation of the insertion point of a tendon to bone
causes of enthesitis?
-traumatic stress e.g during repetitive sport
-autoimmune inflammation
What is commonly associated with Enthesitis related arthritis?
Anterior uveitis
Common sites of inflammation in enthesitis related arthritis ?
-Interphalangeal joints in the hand
-Wrist
-Over the greater trochanter
-Quadriceps insertion at the ASIS
-Quadriceps and patella tendon insertion
-Base of achilles, at the calcaneus
-Metatarsal heads on the base of the foot
Signs of juvenile psoriatic arthritis?
-Plaques of psoriasis
-Pitting of the nails (nail pitting)
-Onycholysis, separation of the nail from the nail bed
-Dactylitis, inflammation of the full finger
-Enthesitis
What is Patent ductus arteriosus?
-when the ductus arteriosus fails to close completely within the first 2-3 weeks of life
Risk factors for PDA
-PREMATURITY
-rubella infection during pregnancy to the mother
-FHx
Presentation of PDA (5)
-SOB
-Difficulty feeding
-Poor weight gain
-Lower respiratory tract infections
-tachypnoea
Pathophysiology of PDA?
-pressure in AORTA is greater than that in pulmonary vessels
-causes L to R shunt
-increases pulmonary vessel pressure (pulmonary HTN)
-leads to RHS overload and hypertrophy
-Can then lead to LVH
What heart sound in PDA?
Continuous machinery murmur
- can obscure the second heart sound
How to diagnose PDA
-ECHO
- can be used in conjunction with Doppler to assess L to R shunt
Managment of PDA?
-monitor until 1 year old using ECHO
-NSAIDs may be used to encourage the closure of PDA
-trans catheterisation
-surgically close
What disease do the newborn blood spot test test for?
-congenital hypothyroidism
-sickle cell
-cystic fibrosis
-phenylketonuria
-beta thalassaemia
-MCAD deficiency
What is involved in the septic screen
- blood cultures
- bloods - FBC, U+E, glucose
- lactate
- LP considered
- CXR
- urine sample
Most common fractures associated with childhood abuse (3)
Radial
Humeral
Femoral
Factors which point to childhood abuse (4)
-story inconsistent with injuries
-repeated attendances at A&E departments
-delayed presentation
-child with a frightened, withdrawn appearance - ‘frozen watchfulness’
Physical signs of childhood abuse (6)
bruising
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
torn frenulum: e.g. from forcing a bottle into a child’s mouth
burns or scalds
failure to thrive
sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas
