Orthopaedic + Rheum Flashcards
What is the pathophysiology of HSP?
IgA vasculitis that presents with a purpuric rash which affects lower limbs and buttocks in children under the age of 10 - triggered by URTI or gastroenteritis
What are the classical features of HSP?
- purpura - symmetrical, non-blanching
- joint pain
- abdominal pain
- renal involvement - oedema
What initial investigations are carried out for HSP?
FBC + blood film + CRP
blood cultures
renal profile
albumin
urine protein:creatinine ratio
How is HSP diagnosed?
Diffuse abdominal pain
Arthritis or arthralgia
IgA deposits on histology (biopsy)
Proteinuria or haematuria
How is HSP managed?
*supportive analgesia + hydration
potentially steroids
monitor urine dipstick for haematuria, BP for HTN
4-6w recovery without renal involvement
What is reactive arthritis?
most common form of arthritis in childhood - following an infection
eg: enteric –> salmonella, shigella
How does reactive arthritis present?
joint pain + swelling
erythema
conjunctivitis or uveitis
dysuria
How is reactive arthritis diagnosed?
clinical
blood, stool, urine tests for infection
XR normal
How is reactive arthritis managed?
NSAIDs with full recovery
underlying infection management
steroid injection –> if significant swelling + pain
What is septic arthritis?
infection within the joint result from haematogenous spread, infected skin lesions
eg: staph. aureus, N. gonorrhoea etc
What pathogens must you consider in septic arthritis?
common - staph. aureus
sexually active - N. gonorrhoea
other - strep. pyogenes, H. influenzae
How does septic arthritis present?
single joint - hip or knee often
rapid onset - hot, red, swollen, painful joint, refuse weight bearing, systemic sx
*LIMPING CHILD
How must septic arthritis be investigated?
FBC, cultures
USS effusion
XR - widening of joint space and tissue swelling
Joint aspiration (pre-antibiotic) - gram staining, crystal microscopy, cultures, sensitivities
How is septic arthritis treated?
IV Abu 3-6w
eg: flucloxacillin, ceftriaxone for N-gonorrhoea
irrigation and debridement of affected joints +/- prosthetic joint
What is juvenile idiopathic arthritis?
persistent joint swelling of >6w with absence of other infection or cause
*7 types
How might JIA present?
joint swelling and stiffness after rest
intermittent limp in young
systemic - subtile salmon pink rash
What investigations are carried out in JIA?
FBC, ESR, CRP
ANA
RF
anti-CCP etc
How is JIA managed?
*aim to reduce inflammation, minimise sx, maximise function
NSAIDs, steroids
DMARDs + biologics
What are some differentials for a limping toddler?
transient synovitis - viral infection alongside
fracture
non-accidental injury
DDH
What are some differentials for a limping child?
transient synovitis
perthes - AVN of femoral head
JIA - painless limp
What are some differentials for a limping adolescent?
slipped capital femoral epiphysis - obese
JIA
