Paed Rheumatology Flashcards
What is the commonest chronic rheumatological disease in children?
JIA
What pro inflammatory markers are present in JIA?
TNF
Inerleukin 1 and 2
Criteria for JIA
At least 6 weeks morning stiffness or swelling irritability or refusal to walk in toddlers school absence or limited ability to participate activity Rash / fever fatigue Poor appetite / weight loss Delayed puberty
Differential diagnosis of JIA
Septic arthritis Osteomyelitis Transient synovitis Malignancies e.g. lymphoma, neuroblastoma, bone tumours Recurrent haemarthrosis Vascular abnormalities Trauma Others
Signs of JIA
Swelling : periarticular soft tissue oedema / intraarticular effusion / hypertrophy of synovial membrane
Tenosynovitis (swollen tendons)
Pain
Joint held in position of maximum comfort
Range of motion limited at extremes
Presentation of systemic JIA
Unwell Arthritis Intermittent fever > 2 weeks Salmon pink erythematous rash Generalised lymphadenopathy serositis hepatomegaly/splenomegaly High inflammatory markers
Investigations for JIA
Labs
Plain x ray
USS
MRI with contrast
Treatment of JIA
NSAIDs DMARDs Biologics Intra-articular / oral steroids Psychological counselling School life / physical adjustments Nutrition particularly to address anaemia or generalised osteoporosis Physio OT
Remission when using intra-articular steroids (IAS)
Remission > 6 months 84%
What type of JIA does IAS have must success in?
Oligoarticular
What is the DMARD of choice in JIA?
Methotrexate
How is methotrexate mostly given in JIA?
Injectable (subcutaneous) form
What needs to be done when on methotrexate?
Blood monitoring
When are biologics used in JIA?
Failure to respond to DMARD
What biological agents are commonly used?
Anti TNF
What is uveitis associated with?
JIA
What can uveitis progress to if untreated?
Chronic uveitis
All children with JIA undergo screening for what?
Uveitits
What kind of JIA is uveitis more common in?
ANA positive oligo JIA
Presentation of uveitis
Red eyes
headache
reduced vision
Complications of uveitis
Cataracts
Glaucoma
Blindness
investigations of uveitis of JIA
Slit lamp examination
Treatment of uveitis
Initially topical steroids to reduce inflammation
More severe need systemic steroids
Poor response to steroids DMARD and biologics
Complications of JIA
Poor growth Localised growth disturbances Micrognathia contractures ocular complications
Who may be hypotonic on examination?
An acutely ill child
What is hypotonia associated with?
Encephalopathy in the newborn period most commonly caused by HIE
Central causes of hypotonia
Downs syndrome
Prader willi syndrome
Hypothyroidism
CP (may precede the development of spasticity)
Neurological and muscular causes of hypotonia
Spinal muscular atrophy Spina bifida Gullian barre syndrome Myasthenia gravis Muscular dystrophy Myotonic dystrophy
