Paediatric Rheumatology Flashcards
1
Q
what is pGALS?
A
- a useful and quick tool to assess all joints and guide further detailed examination.
2
Q
when does a limp require referral?
to paediatrics, paediatic rheumatology or paediatric orthopaedics
A
- persisting beyond 2 weeks
3
Q
what are some red flag symptoms in a child with a limp?
A
- a febrile child with a limp, or a non-weight bearing child, needs same day assessment.
- Red flag features: high fever, weight loss, night pain, lethargy or a new cardiac murmur.
- ask about history of recurrent fevers > can indicate presence of sub-acute or chronic brucellosis.
4
Q
septic arthritis clinical features
A
- acute onset of fever
- joint pain and swelling
- ill appearance
- irritable
- tachycardia
- joint effusion
- periarticular warmth and tenderness
- pain on movement
5
Q
septic arthritis investigations
A
- elevated CRP and ESR
- FBC: raised WBC and platelets
- blood cultures although results may be negative
- US helpful to identify effusions
6
Q
septic arthritis management
A
- referral to orthopaedics
- IV Abx
- joint aspiration
7
Q
what is SUFE associated with?
A
- adolescent
- obesity
8
Q
what happens in Perthes disease?
A
- idiopathic avascular necrosis of hip
- peak age 5-7 years
- M > F
9
Q
Perthes disease management
A
- minimal weight bearing
- paediatric orthopaedics
- contain the head within acetabulum with use of splints
- occasional surgery (osteotomy)
10
Q
Juvenile idiopathic arthritis (JIA) symptoms
A
- arthritis for at least 6 weeks
- morning stiffness or gelling
- refusal to walk in toddlers
- school absence or limited ability to participate in physical activity
- rash/fever
- fatigue
- poor appetite/weight loss
- delayed puberty
11
Q
signs of JIA
A
- swelling
- tenosynovitis (swollen tendons)
- tenderness
- joint held in position of maximum comfort
- range of motion limited at extremities
12
Q
what are the clinical features of systemic JIA?
accounts for 5-15% of JIA
A
- unwell
- arthritis
- intermittent fevers > 2 weeks
- salmon pink erythematous rash
- generalised lymphadenopathy
- serositis
- hepatomegaly/splenomegaly
- high inflammatory markes
- uveitis
13
Q
JIA investigations
A
- Labs
- plain x-ray
- US
- MRI with contrast
14
Q
JIA pharmacological management
A
- NSAIDs
- DMARDS such as methotrexate
- biologic agents if failure to respond to DMARD, anti-TNF agents commonly used
- intra-articular and oral steroid
15
Q
treatment of JIA associated uveitis
A
- slit lamp exam
- initially topical steroids to reduce inflammaton
- more severe need systemic steroids
- poor response to steroids > DMARD and biologics
16
Q
complications of JIA
A
- poor growth
- osteopenia
- localised growth distrubances
- micrognathia
- contractures
- ocular complications
