Ortho/Rheum Flashcards
What is Henoch-Schonlein purpura?
IgA vasculitis
presents with purpuric rash affecting lower limbs and buttocks in children
Inflammation occurs in the affected organs due to IgA deposits in the blood vessles
Where does HSP affect?
- skin
- kidneys
- GI tract
What triggers HSP?
- upper airway infection
- gastroenteritis
Most common age group to be affected by HSP?
Under 10
4 Classic features of HSP?
- purpura
- joint pain
- abdo pain
- renal involvement
How does HSP present?
- Purpura- usually starts on legs and spread to the buttocks and can also affect trunk and arms- skin ulceration and necrosis may develop
- Arthralgia or arthritis- knees and ankles, joints may become swollen and painful
- Abdo pain- can lead to GI haemorrhage, intussuception and bowel infarction
- IgA nephritis- haematuria (micro or macro) and proteinuria–> 2+ or more protein on dipstick–> nephrotic syndrome
Investigations for HSP?
- A-E- EXCLUDE: meningoccocal septicaemia, leukaemia
- Bedside:
urine dipstick- for proteinuria, BP- for hypertension - Bloods:
FBC and blood film- thrombocytopenia, sepsis and leukaemia
Renal profile: kidney involvement
Serum albumin: nephrotic syndrome
CRP: sepsis
Blood cultures: sepsis
Urine protein: creatinine ration: quantity of proteinuria
What is the criteria to diagnose HSP?
- EULAR/PRINTO/PRES criteria
- Requires: palpable purapura + at least one of:
- Diffuse abdo pain
- Arthritis
- IgA depostis on histology
- proteinuia or haematuria
Management of HSP?
- Supportive with simple analgesia, rest and hydration
- steroid may be considered if severe GI or renal involvement
- Monitor closely:
Urine dipstick: renal involvement
BP: hypertension
Prognosis of HSP?
- Abdo pains settles within a few days
- Pts w/o kidney involvement expect to recover within 4-6 weeks
- 1/3 pts have recurrence of diease within 6 months
- v small proportion will develop ESRD
What is transient synovitis?
triggers, aetiology
- Irritable hip
- generally presents as acute hip pain following a recent viral infection
- commonest cause of hip pain in children.
- typical age group is 3-8 years.
Features of transient synovitis?
- limp/refusal to weight bear
- groin or hip pain
- a low-grade fever is present in a minority of patients
- high fever should raise the suspicion of other causes such as septic arthritis
What is imp to exlucude if child presents with ?transient synovitis?
- SEPTIC ARTHIRITIS
- if child has fever- red flag- needs specialist assessment
Managment of transient synovitis?
- Self-limiting
- requiring rest and analgesia
Ddx for purpuric rash?
- meningococcal septicaemia
- Leukaemia
- HSP
- idiopathic thrombocytopenic purpura
- Haemolytic uraemic syndrome
Epidemiology of septic arthritis in children?
4-5 in 100,000
More common in M:F= 2:1
Where is most commonly affected in septic arthritis?
- hip
- knee
- ankle
Symptoms of septic arthritis?
- joint pain
- limp
- fever
- systemically unwell; lethargy
Signs of septic arthritis?
- swollen red joint
- typically, only minimal movement of affected joint is possible
Investigations in septic arthritis?
- joint aspiration for culture- will show increase WBC
- raised inflammatory markers
- blood cultures
What is the Kocher criteria for the diagnosis of septic arthritis?
- fever > 38.5 degrees
- non-weight bearing
- raised ESR
- raised WCC
What is reactive arthritis?
- HLA-B27 associated seronegative spondyloarthropathies
- Defined as: arthritis that develops following an infection where the organism cannot be recovered from the joint
What is the ‘classic’ triad of reactive arthritis?
Urethritis, conjunctivitis and arthritis
* this used to be called Reiter’s syndrome- now reactive arthritis encompasses this
can’t pee, can’t see, can’t climb a tree
What is the ‘classic’ triad of reactive arthritis?
Urethritis, conjunctivitis and arthritis
* this used to be called Reiter’s syndrome- now reactive arthritis encompasses this
can’t pee, can’t see, can’t climb a tree
What organisms are associated with reactive arthritis?
- Shigella felxneri
- Salmonella typhimurium
- Salmonella enteritidis
- Yersinia enterocolitica
- Camplylobacter
Chamydia can also cause it- not AS relevant in children
What is the time course of reactive arthritis?
- Typically develops 4 weeks of initial infection
- Symptoms last around 4-6 months
- 25% of patients have recurrent episodes
- 10% of patients develop chronic disease
Features of reactive arthritis?
- Arthritis: asymmetrical oligoarthritis of lower limbs
- Dactylitis
- Symptoms of urethritis
- Conjunctivitis
- Anterior uveitis
- circinate balanitis (painless vesicles on the coronal margin of the prepuce)
- keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
Management of reactive arthritis?
- Symptomatic: Analgesia, NSAIDs, intra-articular steroids
- Sulfasalzine and methotrexate are sometimes used for persistent disease
- Symptoms rarely last more than 12 months
