Paediatric Rheumatology

Question 1

What is the epidemiology of juvenile idiopathic arthritis?

Answer 1

Epidemiology
2-23/100,000 children
Susceptible genetics | immune response | pro inflammatory markers | presence of antibodies
Most common rheumatological disease in children
May have FH

Question 2

What are the medical and surgical differential diagnosis of a limp/joint pain in children?

Answer 2

Septic arthritis
SUFE 
Osteomyelitis
Transient synovitis
Perthes Disease 
Malignancies
Non accidental injury 
Recurrent haemarthrosis
Vascular abnormalities
Trauma 
Other

Question 3

What is transient synovitis?

Answer 3

Inflammation in the hip joint. Symptoms last <1 week. Fever absent or low grade, usually 3-8yo. Pain and limited movement of the hip. Not unwell looking. On US you see bilateral effusion and resolves spontaneously and can manage pain with paracetamol, ibuprofen etc.

Question 4

What are the clinical manifestations and types of JIA?

Answer 4

Symptoms: arthritis >6 weeks, morning stiffness or gelling, irritability or refusal to walk in toddlers, school absence or limited ability to participate, rash/fever, fatigue, poor appetite/weight loss, delayed puberty

Signs: swelling, tenosynovitis, holding joint in position of comfort, limited range of motion

Types:

• systemic
• oligoarthritis
• polyarticular arthritis (RF -ve)
• polyarticular arthritis (RF +ve)
• psoriatic arthritis
• enthesitis related arthritis
• undifferentiated arthritis

Question 5

How do you investigate and assess JIA and joint pain?

Answer 5

Investigations include labs (FBC, blood culture), x ray, ultrasound, mri with contrast (rare as for young children will need to be sedated)

Assess history, examination and investigations

For systemic: intermittent fever >2wk, rash, high inflammatory markers, unwell, serositis, hepato/splenomegaly

Question 6

What are the principles of management of JIA and other inflammatory joint pathologies?

Answer 6

Management: NSAIDS (short term) disease modifying drugs, biologics, intra-articular and oral steroids

IAS: safe and effective, no long term effects
DMARDs: methotrexate, requires blood monitoring, mostly injected
Biologics: after failure to respond to DMARD, commonly anti TNF