Paediatric Rheumatology

Question 1

Benign Rheumatology symptoms

Answer 1

Worse with Activity better with rest
Worse at the end of the day
If night pain is relieved with simple analgesia

Question 2

Benign rheumatology signs

Answer 2

No joint swelling
No bony tenderness
Normal Strength
Normal Height and weight growth

Question 3

Red flag symptoms

Answer 3

Fever
Malaise/Lethargy
Morning joint pain on stiffness
night pan refractory to simple analgesia and symptomatic during the day time

Question 4

Red Flag Signs

Answer 4

Joint swelling
Bony tenderness to palpation
muscle weakness
fall in height or weight growth curve

Question 5

Juvinile idiopathic Arthritis

Answer 5

Arthritis for at least 6 weeks
Morning stiffness
Irritability or refusal to walk in toddlers
School absence
Limited ability to participate in physical activity
Rash/Fever
Fatigue
Poor appetite/wt loss
Delayed Puberty

Question 6

DDx of JIA

Answer 6

Septic Arthritis 
Transient synovitis
Malignancy
Recurrent haemarthrosis
Vascular abnormalities
Trauma

Question 7

Oligo/Pauciarticular - 40-60%

Answer 7

4 or fewer joints affects (sometimes as many as 9)

Affects large joints with no symmetry

Question 8

Late onset oligoarticular JIA

Answer 8

ANA -ve
NO EXTRA-ARTICULAR MANIFESTATIONS
Hip involvement

Question 9

Early onset Oligoarticular Jia

Answer 9

ANA +ve
Uvititis
Joints commonly affected: Knees, Ankles, feet, hands, wrists
NO HIP

Question 10

Polyarticular JIA

Answer 10

Five or more joints involved
Few or no systemic manifestations
   Fever
   HSM
   Lymphadenopathy
   Pericarditis
   chronic uveitis 
TMJ injury common --> limited bite and Micrognathia 
Onset may be acute but more commonly insidious
Large, fast growing joints affected most

Question 11

Seronegative Polyarticular JIA

Answer 11

RF Negative
M/c in children <5
m/c in girls

Question 12

Seropostitive Polyarticular JIA

Answer 12

RF positive
M/c in children >8
m/c in girls
Basically just Rhematoid Arthritis for kids

Question 13

Enthesitis related JIA required 2 of 6…

Answer 13

onset of Poly/oligoarticular arthritis in a boy >8 years of age

HLA-B27 positive

Acute Anterior Uveitis

Inflammatory spinal Pain

SI joint tenderness

FHx of enthesitis related JIA

Question 14

Psoriatic JIA should have 2 of the 3 following

Answer 14

FHx of psoriasis

Dactylitis - Finger or toe inflammation

Onycholysis - Nail Pitting

PLUS THE MUST HAVE - HLA-B27 positive

Question 15

Systemic JIA - STILL’s disease

Answer 15

5-15% of JIA
Unwell with Arthritis 
Intermittent Fever > 2 weeks
Salmon Pink Erythematous rash 
Generalised lymphadenopathyy
Serositis - inflammation of a serous membrane
H/SM
high inflammatory markers

Question 16

Ix of JIA

Answer 16

Labs - for various blood markers
   ESR, CRP, HBLA-27, ANA
Plain X-ray
US
MRI with Contrast

Question 17

Early therapy Rx of JIA

Answer 17

Conservative and MDT support
NSAIDs/DMARDs

Methotrexate is DMARD of choice - should be used early for good outcome
most given in S/c injection
not many s/e
Blood monitoring required

Question 18

Long term Rx of JIA

Answer 18

Intra-articular and oral Steroids

IA = Greater efficiency in oligoarticular JIA
Safe and effective
No long term S/E

Question 19

Treatment of Uveitis

Answer 19

Not detected my ophthalmoscopy
All JIA pts are to be seen within 6 weeks of Dx
High risk Children

Initially Topical Steroids to decrease inflammation
More severe cases require systemic steroids
Poor response to steroids –> DMARD and Biologics
early detection and treatment is key to a good prognosis

Question 20

Complications of JIA

Answer 20

Poor Growth
Localised growth disturbances
Micrognathia 
COntractures
Ocular complications