paediatric rheumatology Flashcards
When should a paediatric limp be referred
If it persists beyond 2 weeks
What are red flag rheumatological symptoms in a child
- Febrile child with a limp
- Non weight bearing child
- High fever
- weight loss
- night pain
- lethargy
- New cardiac murmur
What is the presentation of septic arthritis in children
- Acute onset of fever
- Joint pain and swelling
- Child appears ill
- Irritable
- Tachycardia
- Joint effusion
- Periarticular warmth and tenderness
- Pain on movement
What labs are found in septic arthritis
- Elevated CRP and ESR
- Raised WBC and platelets
What is the management of septic arthritis in children
- Orthopaedic referral
- IV antibiotics
- Joint aspiration
What is the presentation of SUFE - solipped upper femoral epiphyses
- Obese male
- 10-18 years
- Groin pain
- referred knee pain
- limping
- altered gait
- worse with activity
What is the appearance of SUFE on Xray
Ice cream slipping off cone
What is the presentation of transient synovitis in children
- Pain and limited movement in hip
- Symptoms for less than a week
- No or low fever
- appears well
- Bilateral effusion seen on ultrasound
- Internally rotated hip is common
How is transient synovitis treated
NSAIDs and bed rest
What is the presentation of perthes disease
- Insidious hip pain and limp
- Not relieved by medication or rest
- usually males
- primary school age
What is the management of perthes disease in children
- Minimal weight bearing
- contain head of femur within acetabulum using splints
- Osteotomy if surgery is indicated
What is the presentation of Juvenile idiopathic arthritis
- Arthritis for at least 6 weeks
- Morning stiffness
- Refusal to walk
- Rash
- Fever
- Poor appetite
- Weight loss
- Delayed puberty
What is seen on examination of JIA
- Swelliung
- Tenosynovitis (swollen tendons)
- Tenderness
- Joint held in a position for maximum comfort
- Limited range of motion
What is the presentation of Systemic JIA
- Unwell
- Arthritis
- Intermittint fever for more than 2 weeks
- Salmon pink erythematous rash
- Lymphadenopathy
- Serositis
- Hepatosplenomegaly
- high inflammatory markers
What is the treatment of JIA
- NSAIDs
- DMARDs : methotrexate
- biologics: anti TNF
- intra-articular or oral steroid
What eye issue is associated with JIA
Uveitis
What type of JIA is uveitis more common in
ANA+ oligo JIA
What is the presentation of uveitis
- Red eyes
- Headache
- Reduced vision
What is the treatment of uveitis
- Topical steroids
- Systemic steroids
- DMARDs and biologics
