Musculoskeletal disease Flashcards
What are some differentials for joint pain in children?
Septic arthritis
Juvenile idiopathic arthritis
Haemophilia
Reactive arthritis
Psoriasis
Trauma
Chrons disease
HSP
What is JIA?
Joint inflammation lasting for 6 weeks for which no other cause is found.
What is the epidemiology of JIA?
1 in 1000 children affected
What is the classification of JIA?
Systemic - Still’s disease - 9%
Polyarticular (>4 joints) 19%
Pauciarticular (<4 joints) - 49%
Spondyarthropathies - 7%
Juvenile psoriatic arthritis - 9%
What is pauciarticular JIA?
The most common type of JIA
Usually affects large joints (knees, ankles, elbows)
Commonly affects girls under 4
Minimal systemic symptoms
What are some biomarkers for pauciarticular JIA?
ANA +VE
RF -ve
What is pauciarticular JIA?
<4 joints affected
What needs to be screened for in children with pauciarticular JIA?
Screen for chronic uveitis
Slit lamp testing
What are some useful tests for joint disease in children?
FBC
ASOT
Rheumatoid factor + ANA
Titers (viral)
Viral titres
ANA
Radiology
Ultrasound
CRP
Aspiration
What is the prognosis of pauciarticular JIA?
80% of cases will resolve
What are the features of polyarticular JIA?
Less common than pauciarticular JIA
Symmetrical involvement of small and large joints
There may be poor weight gain and mild anaemia
Morning stiffness
Irritability in young children
What biomarkers are seen in polyarticular JIA?
ANA +ve
RF -ve
What is the prognosis of polyarticular JIA?
12% develop severe arthritis
Low risk of eye involvement
What is polyarticular JIA?
> 4 joints affected
symmetrical
large and small
TMJ involvement?
What is Still’s disease?
Adult onset Still disease, also known as systemic onset juvenile idiopathic arthritis, is a rare systemic inflammatory disorder characterized by inflammatory polyarthritis, daily fever, and a transient salmon-pink maculopapular rash. A serum ferritin level of more than 1000 ng/ml is common in this condition.
What are the features of Still’s disease?
Spiking fever, severe malaise
Salmon pink rash
Anaemia
Weight loss
Arthralgia
Pericarditis
Myalgia
May resemble malignancy
Hepatosplenomegaly
What is a mnuemonic for Still’s disease?
SPARAMOS
Pericarditis
Arthralgia
Rash - salmon pink
Anaemia
Myalgia
Organomegaly
Spiking fever
Suggest how swollen joint pain and fever should be managed in ED?
How should JIA be managed?
Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), reduce pain and swelling. …
Disease-modifying antirheumatic drugs (DMARDs). …
Biologic agents. …
Corticosteroids.
How do growing pains normally manifest?
Preschool children
Pain often by night, but no limp by day
Often bilateral and felt in shins or thighs
Healthy and no interference of ADLs
How does transient synovitis normally present?
Benign and common in children age 2-8 years
Limp resolves by 1-3 weeks
No systemic symptoms
Often proceeded by URTI
How does septic arthritis present?
Looks septic, hot and swollen
How does osteomyelitis normally present?
Fever, swelling, erythema,
High CRP and WCC
Use radiography to distinguish from septic arthritis
How does Legg-Perthes normally present?
4:1 ratio males:females
Age 4-11
Peak at 4-7
Initially painless
Pain and limp when fracture occurs
Diagnosed by radiography
How does SUFE present normally?
Restricted internal rotation of hips
Worse if overweight
Gradual onset groin pain
Diagnosis by X fray frog lateral pelvis
How should the X ray be done for SUFE?
Frog lateral pelvis
What else may cause leg pain and limp in a child?
R/O tumours and malignancy
Pain, tenderness and a mass
Destructive mass on radiography
Gnawing pain in leukemia
What investigations should be done for limp pain?
FBC
ESR
MRI
US
Radiography
What is shown here?
Pectus carinatum
What is shown in the picture on the right?
Pectus excavatum
What is shown here?
Plagiocephaly
What is VACTERL?
