Paediatric Rheumatology Flashcards
What are growing pains?
Growing pains do exist but need careful consideration to not miss pathology
Should not cause a limp
What is pGALS?
Paediatric gait, arms, legs and spine exam
Tool to assess all joints and guide further detailed examination
How long does a limp last to need referral?
Lasting more than 2 weeks
What are red flags for a limping child?
A febrile child, non-weight bearing child, high fever, weight loss, night pain, lethargy and new cardiac murmur
What is the presentation of septic arthritis?
Acute onset fever with joint pain and swelling
Ill appearance, irritable and tachycardic
Joint effusion, periarticular warmth + tenderness and pain on movement
What lab tests are needed for septic arthritis?
Elevated CRP and ESR
Raised WBC and platelets
Blood cultures done but may be negative
US helpful to identifying effusions
What is the management of septic arthritis?
Referral to orthopaedics, IV antibiotics and joint aspiration
What is SUFE - slipped upper femoral epiphysis?
Displacement of capital femoral epiphysis from femoral neck
Most common hip disturbance of adolescence
Associated with obesity, pain + altered gait and worse with activity
What is shown on X-ray of SUFE?
Ice cream slipping off cone
Referral to orthopaedics
What is transient synovitis?
Pain + limited movement in hip, common and 3-8 year old group
Symptoms under 1 week
Fever absent/ low grade, US bilateral effusion and resolves gradually with conservative therapy
What is Perthes disease?
Idiopathic avascular necrosis of the hip
Presents as insidious hip pain + limp
Pain not relieved by rest or medication
3-12 yrs - peaks 5-7 yrs and more females
Bilateral in 10-20%
What is the management of Perthes disease?
Minimal weight bearing, referral to paediatric orthopaedics, contain the head within acetabulum with splints and occasional surgery
What should always be considered in limping child?
Non-accidental injury and malignancy
What are the symptoms of juvenile idiopathic arthritis (JIA)?
Arthritis for at least 6 weeks, morning stiffness or gelling, refusal to walk in toddlers, school absence/ limited ability to participate in physical activity, rash/ fever, fatigue, poor appetite, delayed puberty and weight loss
What are the types of JIA?
Oligoarthritic - 4 or less joints involved
Polyarthritis (RF + or -) - 5 or more joints involved
Enthesitis related arthritis
Psoriatic arthritis
Systemic onset JIA
Undifferentiated arthritis
What are the signs of JIA?
Swelling, tenosynovitis (swollen tendons), tenderness, joint held in position for max comfort and range of movement limited
Describe systemic onset JIA
5-15% of JIA
Child is unwell, arthritis, intermittent fever > 2 weeks, salmon pink erythematous rash, generalised lymphadenopathy, serositis, hepatosplenomegaly and high inflammatory markers
What are investigations for JIA?
Labs - blood test
Plain X-rays
US
MRI with contrast
What are the goals of treatment for JIA?
Pharmacological management consisting of NSAIDs, disease modifying antirheumatic drugs, biological agents and intra-articular/ oral steroids
Nutrition
PT and OT
Describe intra-articular steroids
Highly efficacious
Remission for more than 6 months
Success in oligoarthritis
Safe and effective
Describe DMARDs
Methotrexate is DMARD of choice
Should be used early for good outcomes
Most given SC form
Not many side effects but blood monitoring done
When are biologics used?
Failure to DMARDs
Anti-TNF agents used
Good safety profile
New biologics
Describe uveitis and JIA
Associated with JIA
Untreated can progress to chronic uveitis
Common in ANA positive oligo JIA and under 5 years
Rarely symptomatic but can have red eye, headache and reduced vision
What can untreated uveitis lead to?
Cataracts. glaucoma and blindness
What is the treatment of uveitis?
Slit lamp examination within 6 weeks of diagnosis
Topical steroids and severe need systemic steroids
Poor response to steroids then DMARDs and biologics
Early detection and treatment - prognosis good
What are some complications of JIA?
Poor growth, osteopenia, localised growth disturbances, micrognathia, contracture and ocular complication
