Lecture Day 2: Paediatric Rheumatology Flashcards
Most common autoimmune rheumatology condition
Name others
Juvenile idiopathic arthritis
Other autoimmune diseases: SLE Juvenile dermatomyositis Sarcoidosis Scleroderma Vasculitides e.g. PAN, complex Kawasaki/ HSP
What is periodic fever syndrome
by recurrent episodes of systemic and organ-specific inflammation due to problems of innate immune system (autoimmune conditions are adaptive).
e.g. Familial Mediterranean Fever
Taking Hx
Parental concerns and anxieties
History of presenting complaint: Onset, radiation, duration, severity, pattern, Factors that improve or worsen symptoms,
Potential triggers, such as trauma, infection or immunizations
Severity and impact on function, including school
Associated features- fever/ rash/ lethargy/ weight loss
PMH/ DH/ FH
Differntiate between mechanical, inflammatory
Mechanical: activity
Inflammatory: swelling in moring
Night pains in children
‘Growing pains’
‘bone pain’: can wake them up. leukaemia, bone tumors
Exam joint
MSK problems
Unexplained fever
3 year old girl brought to A+E Started walking at 16 months 1 week previously had URTI Fever and limp for 1 day Now refusing to walk Eating OK Temp 37.4°C, comfortable at rest, painful restriction of left hip, other leg joints fine
Infection in the joints?
Infection triggering the joint?
- irritable hip/transient synovitis
- septic arthritis
- idiopathic avascular necrosis of femoral head
- acute lymphoblastic leukaemia
Test for this girl
FBC, CRP, blood culture X-ray (hip dysplasia) Ultrasound Joint aspiration (under GA and before antibiotics) if possibility of septic arthritis MRI (not nec)
Transient synovitis of the hip
Reactive arthritis following viral UTRI
- self limiting, often within 1 week
- low grade fever & uncomfortable
Management
- rule out
- explanation
- NSAIDS
Worry signs (other diagnosis) Unwell High temperature Increasing leg pain Night pain Unable to weight bear Involvement of other joints Persists beyond 2 weeks
4 yr old boy brought by worried and tired parents to see GP:
3 month history of waking at night with bilateral calf pain: 2-3 nights per week
Helped by massage: back to sleep after ½ -1 hr
Pain-free and active during the day
Good appetite and growing well with no other health concerns
Examination of legs normal (normal range of movement, no swelling or pain)
Growing pains
Growing pains
Benign nocturnal pains of childhood
Idiopathic, but many theories
Very common, M=F
(up to 1 in 3 children at some point in some studies)
Most common in 3-5 y or 8-12 y olds
(when growth is at low level)
Intermittent crampy pain in calves, thighs or shin IN THE EVENING OR AT NIGHT
Management:
reassurance
message & simple analgesia
worrying features: Pain during day Joint swelling described /seen Child unwell with other symptoms Abnormal examination Abnormal investigations
4 year old boy
Limp and right knee swelling:
- reduced play
- stiff in mornings
Otherwise well, good appetite, no fever, no pain at night
On examination: all joints fine except right knee:
arthritis
Differentials for arthritis
A Acute Septic Arthritis R Reactive: to infection T Trauma H Haematological: Haemophilia/Leukaemia R Rheumatological: JIA/JDM/lupus I Immunological: HSP T Tuberculosis I Inflammatory Bowel disease S Sarcoidosis
Juvenile idiopathic arthritis
- < 16 yrs old
- no other cause
- arthritis of at least 6 weeks
- swelling, limited joint range, tenderness & pain
- number of joint affect varies
- risk of uveitis (20%)
Examination
Blood tests: rule out leukaemia
Tx:
1: NSAIDs & or intra-articular steroids
2: Methotrexate
6 year old girl
Foot after walking
Writing slow, needs rests after prolonged
Pain in legs at night after lots of activity during the day
Otherwise very well
Mechanical sounding
