Paediatric Rheumatology Flashcards
What are the benign symptoms of paediatric rheumatology?
Worse with activity and better with rest
Worse at the end of the day
If night pain, relieved with simple analgesics
What are the benign signs of paediatric rheumatology?
No joint swelling
No bony tenderness
Normal strength
Normal height and weight growth
What are the red flag symptoms of paediatric rheumatology?
Fever
Malaise/lethargy
Morning joint stiffness or pain
Night pain refractory to simple analgesia and symptomatic during the daytime
What are the red flag signs of paediatric rheumatology?
Joint swelling
Bony tenderness to palpation
Muscle weakness
Fall in height or weight growth curve
What investigations can be used to diagnose a rheumatological condition?
Bloods Xrays USS MRI Bone scan CT
What is the criteria for oligoarticular JIA?
1-4 joints affected Persistent Extended (more than 4 joints after 6 months)
What is the criteria for polyarthritis?
5 or more joints in first 6 months
What is the presentation of JIA?
Joint pain
Swelling
Stiffness; early morning, relieved by movement
Limp or abnormal gait
Other abnormal posture or movement
Crying or irritability in babies/infants
Regression of milestones in infants
What is the presentation of systemic onset disease in JIA?
Fever Rash Lymphadenopathy, Hepatomegaly/splenomegaly Serositis
What is the differential diagnosis of JIA?
Septic or reactive arthritis Rheumatic fever Connective tissue disorder (SLE) Leukaemia Neuroblastoma Primary bone tumour Perthe's disease Slipped upper femoral epiphysis Congenital hip dysplasia Fracture Referred pain
What investigations should be considered for JIA?
MSK examnation
X ray, MRI
Inflammatory markers (CRP, ESR, WBC, platelets)
What is the management for JIA?
Encourage normal activity Drug treatment Regular ophthalmology review for uveitis screening Physiotherapy Occupational therapy
What is the treatment for JIA?
NSAID Intraarticular joint steroids IV methylpredisolone Methotrexate Biologics
What factors would increase the risk of a poor prognosis of JIA?
Active disease at 6 months Polyarticular onset and course Extended oligoarticular Female Rh factor +ve ANA +ve Persistent raised inflammatory markers
What are the complications of JIA?
Altered growth of limbs Scoliosis Short stature Joint damage / destruction Blindness(untreated uveitis) Psychosocial effects of chronic disease Loss of schooling
