Paediatric arthritis Flashcards
important factor on spetic arthritis
surgical emergency
-irreparable changes in the articular cartilage occur within HOURS of inoculation
top 3 organisms for septic arthitis
staphylococcus aureus
strep pneumonia
Haemophilus influenzae (incidence falling with immunisation)
presentation of septic arthiris excluding the joint 3
systemically unwell
-fever
-headache
-may have another focus of infection (septicasemia, pharyngitis, meningitis, cellulitis)
joints issues
presentation of septic arthitis regarding the joint 5
exquisitely painful
hot
swollen
red
held immobile (pseudoparalysis)
how can joint presentation differ in septic arthitis
joints covered by lots of muscel or subcut itssue (particulary hip) will not be red hot or swollen
those signs are more common in superfical joints
how can presentation in septic arthitis differ
presentation may be more subtle- particulary in neonates
-only physical signs may be irritability and (more importatnly) pseudoparalysis
fact about pesuoparalysis in a neonate 1
is the result of bone/joint sepsis until proven otherwise
differentials for septic arthritis 2
transient synovitis
reactive arthritis
how to differentiate transient synovitis and reactive arthritis from septic arthritis 4
pyrexia >38.5 within last week
inability to weight bear through that limb
raised ESR >40mm/h
WBC >12x10(9)/l
management of septic arthritis 4
ABC- resusitaction if unwell
urgent aspiration (usually under GA) with immediate microscopy and gram stain, subsequenent culure and sensitivity
blood cultures- minimum of 2 (not always postiive)
High dose IV ABx
classical presentation of osteomyelitits 3
acutely unwell child
pyrexia
local erythema and tenderness
what often procedes a subacute presentation of osteomyelitis 1
recent varicella zoster infection
-common
-scratching typically introduced haematogenous spread of S. aureus)
subacute presentation of osteomyelitis 4
point tenderness (often near metaphyses)
night pain
Limp
Remember- Fever may be absent
management of osteomyelitis
blood culture
bone aspiration - if absecee is present
High dose IV ABx
Splintage of the limb
Abx for septic arthritis 3
fluclos
vanc
gent if MRSA
ABx for osteomyelitis 3
fluclox
metro
gent
more insidious cause of septic arthritis and osteomyelitis 1
how to diagnose- 1
tuberculosis
quickly by PCR (cultures take over 6 weeks)
most common cause of joint swelling in children
reactive arthitis
overview of causes of reactive arhtitis
usually by an unidentified viral infection
short lived and self limiting illness
-if persists -> consider other causes
what causes rheumatic fevere
streptococcal pyogenes infection
symtpoms of rhuematic fever (overview) 4
carditis
arthritis
neuro features
rash
neuroogical features in rhuematic fever
sydenham chorea
-rapid ivoluntary movements of the limbs, trunnk and facial muscles
rash in rhuematic fever 1
erythema marginatum
raised biochem in rheuamtic fevere 3
raised ESR
ASO titre
DNase B
managemtn of reheumatic fever 4
antibiotics: oral penicillin V
anti-inflammatories: NSAIDs are first-line
treatment of any complications that develop e.g. heart failure
-need life long penicillin prophylaxis
how is rhuematic fever assocaited with joints
can cause reactive arhtitis
symtpoms of HLA B27 assoacited reactive syndrome
reactive arthitis
urethrisi
conjunctivits ± plantar fascitis
what else is HLA B27 associated reactive syndrome called
REiters syndrome
what type of infections lead to HLA B27 associated reactive syndrome
post enteric or genitourinary infection
-Yersinia
-SHigella
-Salmonella
-E coli
-STDs
managemtn of reactive arthitis in HLA B27 associated reactive syndrome
self-limiting conditino once infection treated
what else is transient synovitis of the hip called
irritable hip
who gets transient synovitis of the hip
idiopathic disorder in children ,3-10yo
-often preceded by infection
presentation of transient synovitis of the hip 3
sudden or gradual onset of hip pain+ limp
hip is held flexed and externally roated
-pain can refer to knee
biochem in transient synovitis of the hip
ESR and WCC are normal or mildly raised
managment of transient synovitis of the hip 2
conservative -analgesi and allow child to rest until happy to weight bear
-condition should resolve after one week
-> if symptoms prolonged or recurrent-> may need to revist diagnosis
overview of discitis
unclear if infective aetiiologu of the spine
-usually self limiting and not associated w culture or organisms
peak onset 1-3 years
-child refuse to walk ± low grade fever
diangosis can be confusion
-should have well localised tendernes of spine
-radiographs normal until alte indisase
-MRI helpful
-if in doubt-> ABx
overview of juvenile idiopathic arthritis
childhood onset of chornic inflammatory arhtitis of unknown aeitology
-no single diagnostic test and investigation aims to exclude other diagnoses
esentatino of juvenile idiopathic arthritis
PERSISTENT joint swelling in one or more joints
inflammatory featurtes of early morning stiffness and warmth
clinical diagnosis w no diagnostic tests
what occurs in 1/3 of juvenile idopathic arthirits
chornic anterior uveitis
-leading cause of child blindness
managemnt of chronic anterior uveitis 2
early referral for regular eye screening by slit lapm
-screening by ophthalmologist
-key to early diagnosis and preservation of vision
types of connective tissue disease in children 4
systemic lupus erythematous (SLE)
dermatomyositis
scleroderma (particulary localised)
Vasculitis
two vascultic conditions more common in children than adults
Henoch Schonlein Purpura
Kawasaki disae
why is henoch schonlein purura important in children 1
because of the assocated renal disease
why is kawasaki disease important
associagted mortality assocaited w coronary artery aneurysms
-preventable with early diagnosis and treatment with IVIG
key early features of kawasaki disease 10
high and persistent evere (>39.5) for 5 days
rash
red palms, soles and perineum
Miserable ( v important sign reflecting aspectic menigeal irritatoin)
mucositis
non-purluent conjunctivits
arthtis
high platelet count
lymphadenopthy
high acute phase response
late features of kawasaki disease 5
aneurysms
peeling skin
cardiac ischaemia
myocardial infarctoin
claudication- where other aneuryms have occured
