MISC Flashcards
MC arthritogenic enteric and GU bacteria
Yersinia
Salmonella
Shigella
Campylobacter
Chlamydia trachomatis
Less common
Chlamydia pneumo
M pneumo
C difficile
ReA gender predilection
M
Organisms responsible for ReA at all ages
Enteric infections
T/F significant prop of patients with ReA are HLA-B27 neg
T
BErlin dx criteria for ReA
Pg 614 box
In ReA: Symptoms of infection usually precede arthritis, enthesitis, or extraarticular disease by
1-4 weeks
Active period of ReA
Weeks to months
T/F Chlamydia GU infection is usually asymptomatic
T
T/F ReA is typically red and warm
T
T/F ReA is typically oligoart
T
Eye finding in ReA occuring in 2/3 of patients
Conjunctivitis
Organism that may cause severe purulent conjunc in ReA
Yersinia
T/F ReA is difficult to distinguish from septic arth
T, do culture
T/F Clincial and lab confirmation of an infectious trigger in children with ReA is often made
F
Usual distinguishing clinical cxs of ReA compared to JIA
More painful
Assoc with erythema of overlying skin
Usual distinguishing clinical cxs of septic arth compared to ReA
Fever and usual monoarticular involvement
Among all rheumatic disease of childhood, this is the only one potentially preventable
ReA
Circinate balanitis (shallow painless ulcers on glans) is seen in what ReA
Chlamydia-triggered ReA
Skin lesions of ReA difficult to distinguish from Psoriasis
Keratoderma blenorrhagicum
T/F Treatment of enteric infection with abx impacts the course of ReA
F
Abx therapy for this organism may be beneficial for altering course ofReA
Chlamydia trachomatis
1st line tx for ReA
NSAIDs
Usual duration of ReA
3-6m
Tx for Keratoderma blenorrhagicum
MTX
Tx for uveitis from ReA
Topical steroids
Most children with ReA achieve within
6-12m
Recurrent arthritis may occur in ReA
T
ARF latency
2-3 weeks
MC clinical presentation of RF
Carditis
Most specific clinical presentation of RF
Carditis
Most serious presentation of RF
Carditis
RF: Patholgocial process underlying inflammatory reaction in various organs
Vasculitis mediated by immune reaction to the strep antigen
Prevention of RF
Timely and appropriate treatment of strep pharyngitis
Peak incidence of RF
6-15years
Low incidence ARF is defined as
2 or fewer new cases per 100,000 children per year
Low prevalence ARF is defined as
1:1000 cases or fewer in the whole population
Strains of strep primarily associated with ARF
Serotype 3 and 18, particularly those that produced mucoid colonies when cultured on blood agar
Susceptibility genes for ARF
HLA-DR 4,2,1,3,7
DRB1*16
Allotype D8/17
Measure neutralizing Abs to purified streptolysin O
ASO
Assays for antibodies to the most ubiquitous of 4 deoxyribonuclease isozymes produced by group A strep
Anti-DNAse B
Antibodies against GAS peak approx ___ after acute infection
2-3 weeks
Only about ___% of patient with ARF mount an ASO response
83
RF: Structures that share cross-reactive antigenic determinants
1) Components of M protein and myocardial sarcolemma
2) Cell-wall carbohydrate and valvular glycoprotein
3) Strep protoplast membrane and neuronal tissue of subthalamic and caudate nuclei
4) Hyaluronate capsule and articular cart
MCC of morbidity and mortality in patients with ARF
Carditis
Older vs younger children with RF: More likely to develop moderate and severe carditis
Young
WAS considered the hallmark of RHD
Pancarditis
Main target and site responsible for pathological and clinical manif of RHD
Endocardium
Hallmark lesion of rheumatic carditis
Valvular insuff
Valves MC affected by RF in order
Mitral > aortic
Murmur of mitral insuff/regurg
High-freq, smooth, holosystolic, apical, radiating to the left axilla, best heard while the patient is in left lat decubitus
Murmur of mitral stenosis
Carey coombs murmur: Mid- to late-diastolic flow murmur
Pulse of AI
Corrigan pulse: Increased pulse pressure asociated with bounding peripheral pulses
Arthritis occurs in about ___% of patients with ARF
70
RF: Most severe clinical manif at presentation
Arthritis
RF clinical manif: Takes the longest to resolve
Chorea and erythema marginatum
RF clinical manif: Rarest
Erythema marginatum
RF clinical manif: Develops last
Chorea
MCC of misdiagnosis of ARF
Arthritis
T/F Arthritis of RF is usually initially monoartic
T
Most prominent symptom of RF arthritis
Pain
T/F Pain of RF arthritis occurs at rest and accentuated by active or passive mvt
T
T/F ARF arthritis treated with NSAIDs may be monoarticu and not follow migratory pattern
T
Sydenham chorea is a manif of involvement of
Basal ganglia and caudate nucleus
Latency period between strep infxn and chorea
2-4 months, sometimes as long as 12 months
T/F involuntary mvts in sydenham chor is usually asymm and disappear during sleep
F, symmetrical, disappear during sleep
T/F Sydenham chor resolves spont
T, in 2-3 weeks, but may persist for months, sometimes, years
PANDAs vs sydenham chorea
Carditis is highly prevalent in SC and not associated with PANDAs
MC loc of erythema marginatum
Trunk and proximal inner aspects of the limbs
T/F ERythema marginatum is accentuated by cold
F, warmth
Usual location of SC nodules of RF
Extensor surface of joints
T/F Overlying skin of SC nodules RF is often discolored
F, also firm, freely movable, painless, and nontender
T/F Trop I is typically elevated in ARF
F
Pathognomonic pathologic finding of rheumatic carditis and occurse MC in patients with subacute or chronic carditis
Aschoff body
Pathologic appearance of SC nodules of RF
CEntral area of fibrinoid necrosis surrounded by loosely demarcated zones of scattered mononuclear cells
An elevated ASO or anti-DNAse B is present in about ___% of patients with ARF
85
Jones criteria
Pg 626 box
Primary agent of choice for eradication of strep
Penicillin IM as single dose (as ben pen g) or orally for 10 days
Tx for mild to moderate RF carditis
Aspirin 80-100mkday in 4 divided doses given for 4-8 weeks depending on clinical response then discontinued gradually in the next 4 weeks
Tx for severe RF carditis and CHF
CS:
Pred 2mkday OD, tapered and withdrawn during the next 2-3 weeks
T/F MPPT is inferior to oral pred in the treatment of RF
T
Should be given prior to termination of oral pred therapy in RF severe carditis
Aspirin, to avoid rebound symptoms and of acute phase reactants
Inflamm marker that is more reliable in monitoring response to antiinflam therapy for RF carditis
CRP
T/F Complete bed rest for patients with acute carditis of RF should be discouraged
T, lead to prolonged confinement and cardiac neurosis
Primary and secondary prevention of RF, regimens
Pg 627 table
Duration of RF arthritis in any one joint
Rarely >1 week
Hallmark of RF arthritis
Exquisite sensitivity to salicylates
Dose of aspirin for RF arthritis
50-75mkday in 3-4 doses, no more than 2 weeks, gradually withdrawn
T/F Mild manifestations of sydenham chorea require only bed rest and avoidance of physical and emotional stress
T
T/F antiinflam agents are need for treatment of RF chorea
F
Major morbidity in RF
Exclusively associated with degree of cardiac damage
Rare form of nonerosive but deforming arthropathy ascribed to RF
Jaccoud arthritis
T/F SC and erythema marginatum in RF are self-ltd with no permanent residua
T
