MSK/Rheum Flashcards
Why should children with juvenile idiopathic arthritis receive frequent slit lamp eye examinations?
A major morbidity of pauciarticular JIA is chronic uveitis, resulting in blindness. About 20% of girls who have the monoarthritis or pauciarticular form of JIA have iridocyclitis (anterior uveitis) as their only significant systemic manifestation. Because this eye disorder can require treatment with local or systemic steroids and develop without signs or symptoms, it is recommended that all children with this form of arthritis have frequent slit-lamp eye examinations.
What is Blount disease (idiopathic tibia vara)?
Bowing of the legs (often unilateral) that is characterized by an abnormality in the medial aspect of the proximal tibial epiphysis. Radiographically there is a prominent step abnormality with beaking and calcification at the proximal tibial epiphysis. Aggressive treatment is essential, as the disease can be rapidly progressive and lead to permanent growth disturbances. Bracing can be effective up to the age of 3; later correction may require surgery.
What is Legg-Calvé-Perthes disease?
Avascular necrosis of the femoral head, caused by an interruption of the blood supply by a currently unknown cause. Onset is usually between 2 and 12 years of age and classically presents with a painless limp, although mild pain of the thigh is common. Affects boys 4-5 fold greater than girls.
What are features of juvenile idiopathic arthritis (JIA)?
JIA frequently causes spindle-shaped swelling of finger joints and can involve unusual joints such as the sternoclavicular joint. Presentation of JIA occurs as either polyarthritis (five or more joints, systemic symptoms not so severe or persistent), pauciarticular (four or fewer joints, lower-extremity joints, extra-articular disease unusual), or systemic disease (severe constitutional disease, systemic symptoms prior to arthritis, rheumatoid rash, high spiking fevers, variable joint involvement, also known as Still’s disease).
What are the manifestations of neonatal lupus (transferred maternal IgG autoantibodies)?
Infants can have thrombocytopenia, neutropenia, rash, liver dysfunction, and a congenital heart block. Most manifestations are self-resolved; however, the congenital heart block is permanent and frequently requires pacing.
What substances are deposited in joints in hemarthrosis (e.g. in hemophilia)?
Causes iron/hemosiderin deposition in the joint if it has been bled into leading to synovitis and fibrosis of the joint
How is a nursemaid’s elbow (subluxation of the radial head) treated?
Gentle hyperpronation of the forearm, or supination of the forearm followed by elbow flexion
What is a palpable “step-off” at the lumbosacral area indicative of in a child or adolescent?
Spondylolisthesis (developmental disorder characterized by a forward slip of vertebrae, usually L5 over S1). Can result in chronic back pain and neurologic dysfunction
When is joint pain worse in juvenile idiopathic arthritis?
The mornings
When is joint pain worse in neoplastic processes?
The evenings/night
How is transient synovitis managed?
Rest and NSAIDs. No further work up needed other than CBC, ESR, and CRP to r/o septic arthritis (significantly elevated WBC, ESR and CRP)
How does Legg-Calvé-Perthes disease present?
Typically in boys age 4-10 with insidious-onset hip or knee pain and an antalgic gait
