Juvenile Idiopathic Arthritis & Other Common Acute Childhood Orthopaedic/Rheumatic Presentations Flashcards
What is the common feature of juvenile idiopathic arthritis?
Swelling or limitation of motion of the joint, accompanied by heat, pain or tenderness, lasting at least 6 weeks.
What are the three subgroups of juvenile idiopathic arthritis and their prevalence?
- Oligoarticular/pauciarticular: 4 joint or less (50-60%)
- Polyarticular: more than 5 joints (30%)
- Less common types (10%)
Pathology
Synovial joint lining becomes inflamed and thickened, causing pain, redness, swelling and joint stiffness.
What percentage of oligoarticular cases are ANA positive?
80%
When is the peak onset of oligoarticular JIA?
1-3 years of age
What percentage of polyarticular cases are ANA positive?
50%
When is the peak onset of polyarticular JIA if RF positive?
Adolescence, persisting into adulthood
When is the peak onset of polyarticular JIA if RF negative?
1-3 years of age
How does polyarticular JIA if RF positive affect the joints?
Symmetric multiple small and large joints
How does polyarticular JIA if RF negative affect the joints?
Often asymmetric multiple small and large joints
What percentage of enthesitis related arthritis cases are HLA B27 positive?
80%
How does enthesitis related arthritis affect the joints?
Assymetric, large joints, including axial skeleton
When is the onset of psoriatic arthritis most common?
Preschool and age 10
What joints are commonly affected in psoriatic arthritis?
Small and large joints, especially DIP
What medical managements are often used for JIA?
- NSAIDs
- Corticosteroids
- Disease modifying anti-rheumatic drugs
- Biologics
- Intra-articular steroid injections
What are the goals of physiotherapy in JIA?
- Decrease pain
- Maintain/improve function and a normal lifestyle
- Educate about disease and its management
- Maintain/increase ROM and muscle strength
- Prevent/correct deformity or abnormal movement patterns
- Encourage activities that support normal development
- Maintain/ improve exercise endurance and aerobic capacity
- Address leg length discrepancy
What is pGALS?
Paediatric Gait Arms Legs and Spine
Pain treatment options for JIA
- Heat or ice
- Joint protection ergonomics
- Pain team referral
- Splinting
- Orthotics
- Self-management techniques
- Pacing and positioning
Use of hydrotherapy
- Reduce Pain & Muscle Spasm
- Increase Joint Range of Movement
- Reduce Joint Stiffness
- Increase Muscle Strength
- Increase Aerobic Capacity
- Increase Fun Element to Program
Use of exercise
- Reduce pain and stiffness
- Maintain joint range of movement
- Increase muscle strength
- Increase stamina
- Increase function
- Increase independence
What education should be involved in the treatment of
- Disease process
- Disease management
- Role of team members
- Reinforce pain management techniques
- Inform and educate school
What should be involved in an exercise program
- ROM
- Muscle strength
- Muscle length
- Cardiovascular endurance
What is osteomyelitis? What is commonly caused by?
Bacterial infection of the bone, caused by staphlococcus Aureus and haemophilius influenzae type B
What are the common symptoms of osteomyelitis in children?
- Fever
- Chills
- Severe pain
- Swelling
- Tenderness
How is osteomyelitis usually treated in children?
- Aspiration
- Antibiotics
- Immobilisation
- Occasionally surgical compression
What is septic arthritis?
An infection of a joint caused by bacterial organisms.
What are the common symptoms of septic arthritis?
- Fever
- Irritability
- Refusal to move affected joint
- Warm, swollen joint held in flexion
How is septic arthritis usually treated?
- Aspiration
- Drainage
- IV antibiotics
What is transient synovitis?
Most common cause of painful hip in children <10 years of age. Lasts about 7 days.
What are the common symptoms of transient synovitis in children?
- Gradual or acute onset limp
- Mild to moderate hip or knee pain
- Mild fever
What is Legg Calve Perthes disease?
Avascular necrosis of the ossific nucleus of the femoral head, due to occlusion of the medial femoral circumflex artery.
What are the common symptoms of Legg Calves Perthes disease?
- Muscle weakness
- ROM limitations
- Tredelenberg gait
How long does the recovery of Legg Calves Perthes disease take?
1-3 years, as the femoral head revascularises
Who does Legg Calves Perthes disease most commonly affect?
Mostly boys, 3-12 years of age
What is slipped capital femoral epiphysis?
Displacement of the growth plate of the proximal femoral physis
What are the common symptoms of acute SCFE?
- Trauma
- Severe pain
- Restricted hip abduction and IR
