Paediatric rheumatology Flashcards
Red flags in paediatric MSK history
Fever, malaise, weight loss, night sweats, reduced appetite
Incongruence between history and presentaion
Unremitting pain, night pain
Differential for acute joint swelling in child
Septic arthritis
Reactive arthritis - enteropathic, viral, streptococcal
Trauma
Differential for chronic joint swelling in child
Juvenile idiopathic arthritis
Haematological e.g. haemophilia
Systemic inflammatory e.g. SLE, sarcoid
Malignancy
Blood tests for paediatric swollen joints
FBC + blood film
CRP/ESR
ANA
ASOT if recent sore throat
ELISPOT if ?TB
Non-blood Ix for paediatric swollen joint
US/MRI of joint
CXR
Ophtho review (JIA signs)
Joint aspirate
Duration of arthritis in JIA
Onset <16y
>6w symptoms
Classification of juvenile arthritis
- Systemic
- Oligoarticular
- Persistent/extended
- Polyarticular
- RF +ve/-ve
- Enthesitis-related
- Psoriatic
- Undifferentiated
Systemic-onset JIA, in addition to joint features, must have one or more of:
Serositis (pericarditis/pleural effusion)
Evanescent erythema (i.e. non-fixed)
Hepato/splenomegaly
Generalised lymphadenopathy
Arthritis features in systemic-onset JIA
>1 joint
Preceded by fever of >2w
daily fevers >3d
Patterns of systemic-onset JIA disease
Monocyclic: one episode then remission
Intermittent: Recurrent episodes with remission in between
Persistent: No remission
Pathogenesis of SO-JIA
IL-6 mediated illness
No immune complexes or autoantibodies detected
Features of oligoarticular JIA
<5 joints affected at any one point
ANA +ve
Assoc w/ anterior uveitis
Mainly affects large joints (knees, ankles)
Epidemiology of oligoarticular JIA
More common in girls
Peak incidence 2-4 yo
Persistent vs extended oligoarticular JIA
Persistent: Total <4 joints
Extended: Cumulative total 5 joints in 6mo
Features of polyarticular JIA
>=5 joints in first 6 months
RF +ve: More symmetrical, more joints
Psoriatic arthritis in children
Arthritis
AND
Psoriasis
OR
2 of: nail pitting, dactylitis, psoriasis in FDR
Enthesitis-associated arthritis in children
Arthritis
AND
Enthesitis
OR
Two of:
HLA B27 +ve
FHx of HLA B27
Sacro-iliac joint involvement
Anterior uveitis
Male >8yo onset
Anterior uveitis presentations in children
HLA B27: Painful red eye
Oligo-articular: silent presentation > chronic anterior uveitis
Complications of chronic anterior uveitis
Glaucoma
Cataract
Cystoid macular oedema
Demographic most at risk for anterior uveitis
Girls
<8yo
ANA +ve
May present within 7 years of onset
Management of JIA
Ibuprofen
Corticosteroid injections
Methotrexate if severe eye; recurrent injections; systemic
Biologics - etanacept, tocilizumab, adalimumab
Management of uveitis in children
Screen every 3-4mo
Topical steroids
Methotrexate
