Juvenile Idiopathic Arthritis & Other Common Acute Childhood Orthopaedic/Rheumatic Presentations

Question 1

What is the common feature of juvenile idiopathic arthritis?

Answer 1

Swelling or limitation of motion of the joint, accompanied by heat, pain or tenderness, lasting at least 6 weeks.

Question 2

What are the three subgroups of juvenile idiopathic arthritis and their prevalence?

Answer 2

1. Oligoarticular/pauciarticular: 4 joint or less (50-60%)
2. Polyarticular: more than 5 joints (30%)
3. Less common types (10%)

Question 3

Pathology

Answer 3

Synovial joint lining becomes inflamed and thickened, causing pain, redness, swelling and joint stiffness.

Question 4

What percentage of oligoarticular cases are ANA positive?

Answer 4

80%

Question 5

When is the peak onset of oligoarticular JIA?

Answer 5

1-3 years of age

Question 6

What percentage of polyarticular cases are ANA positive?

Answer 6

50%

Question 7

When is the peak onset of polyarticular JIA if RF positive?

Answer 7

Adolescence, persisting into adulthood

Question 8

When is the peak onset of polyarticular JIA if RF negative?

Answer 8

1-3 years of age

Question 9

How does polyarticular JIA if RF positive affect the joints?

Answer 9

Symmetric multiple small and large joints

Question 10

How does polyarticular JIA if RF negative affect the joints?

Answer 10

Often asymmetric multiple small and large joints

Question 11

What percentage of enthesitis related arthritis cases are HLA B27 positive?

Answer 11

80%

Question 12

How does enthesitis related arthritis affect the joints?

Answer 12

Assymetric, large joints, including axial skeleton

Question 13

When is the onset of psoriatic arthritis most common?

Answer 13

Preschool and age 10

Question 14

What joints are commonly affected in psoriatic arthritis?

Answer 14

Small and large joints, especially DIP

Question 15

What medical managements are often used for JIA?

Answer 15

• NSAIDs
• Corticosteroids
• Disease modifying anti-rheumatic drugs
• Biologics
• Intra-articular steroid injections

Question 16

What are the goals of physiotherapy in JIA?

Answer 16

• 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

Question 17

What is pGALS?

Answer 17

Paediatric Gait Arms Legs and Spine

Question 18

Pain treatment options for JIA

Answer 18

• Heat or ice
• Joint protection ergonomics
• Pain team referral
• Splinting
• Orthotics
• Self-management techniques
• Pacing and positioning

Question 19

Use of hydrotherapy

Answer 19

• Reduce Pain & Muscle Spasm
• Increase Joint Range of Movement
• Reduce Joint Stiffness
• Increase Muscle Strength
• Increase Aerobic Capacity
• Increase Fun Element to Program

Question 20

Use of exercise

Answer 20

• Reduce pain and stiffness
• Maintain joint range of movement
• Increase muscle strength
• Increase stamina
• Increase function
• Increase independence

Question 21

What education should be involved in the treatment of

Answer 21

• Disease process
• Disease management
• Role of team members
• Reinforce pain management techniques
• Inform and educate school

Question 22

What should be involved in an exercise program

Answer 22

• ROM
• Muscle strength
• Muscle length
• Cardiovascular endurance

Question 23

What is osteomyelitis? What is commonly caused by?

Answer 23

Bacterial infection of the bone, caused by staphlococcus Aureus and haemophilius influenzae type B

Question 24

What are the common symptoms of osteomyelitis in children?

Answer 24

• Fever
• Chills
• Severe pain
• Swelling
• Tenderness

Question 25

How is osteomyelitis usually treated in children?

Answer 25

• Aspiration
• Antibiotics
• Immobilisation
• Occasionally surgical compression

Question 26

What is septic arthritis?

Answer 26

An infection of a joint caused by bacterial organisms.

Question 27

What are the common symptoms of septic arthritis?

Answer 27

• Fever
• Irritability
• Refusal to move affected joint
• Warm, swollen joint held in flexion

Question 28

How is septic arthritis usually treated?

Answer 28

• Aspiration
• Drainage
• IV antibiotics

Question 29

What is transient synovitis?

Answer 29

Most common cause of painful hip in children <10 years of age. Lasts about 7 days.

Question 30

What are the common symptoms of transient synovitis in children?

Answer 30

• Gradual or acute onset limp
• Mild to moderate hip or knee pain
• Mild fever

Question 31

What is Legg Calve Perthes disease?

Answer 31

Avascular necrosis of the ossific nucleus of the femoral head, due to occlusion of the medial femoral circumflex artery.

Question 32

What are the common symptoms of Legg Calves Perthes disease?

Answer 32

• Muscle weakness
• ROM limitations
• Tredelenberg gait

Question 33

How long does the recovery of Legg Calves Perthes disease take?

Answer 33

1-3 years, as the femoral head revascularises

Question 34

Who does Legg Calves Perthes disease most commonly affect?

Answer 34

Mostly boys, 3-12 years of age

Question 35

What is slipped capital femoral epiphysis?

Answer 35

Displacement of the growth plate of the proximal femoral physis

Question 36

What are the common symptoms of acute SCFE?

Answer 36

• Trauma
• Severe pain
• Restricted hip abduction and IR