Paediatric Rheumatology

Question 1

what is the most common arthritis in children?

Answer 1

Juvenile idiopathic arthritis

Question 2

Acute joint pain in young children is most likely caused by?

Answer 2

self - limiting transient synovitis

Question 3

What kind of condition is JIA?

Answer 3

autoimmune

• can be exacerbated by environmental causes eg viruses
• genetics

Question 4

what are the pro inflammatory markers for JIA?

Answer 4

TNF, interleukin 1 & 2.

Question 5

Symptoms associated with JIA? (how can we pick it up?)

Answer 5

• Arthritis for at least 6 weeks
• Morning stiffness or gelling
• irritability or refusal to walk in toddlers
• School absence or limited ability to participate in physical activity
• Rash /fever
• Fatigue
• Poor appetite/wt loss
• Delayed puberty

Question 6

what are some differential diagnoses for JIA?

Answer 6

• Septic arthritis
• Osteomyelitis
• Transient synovitis
• Malignancies i.e lymphoma, neuroblastoma, bone tumours
• Recurrent haemarthrosis
• Vascular abnormalities
• Trauma
  others

Question 7

Clinical signs of JIA?

Answer 7

Swelling: periarticular soft tissue edema/intraarticular effusion/hypertrophy of synovial membrane

• Tenosynovitis (swollen tendons)
• pain
• Joint held in position of maximum comfort range of motion limited at extremes.

Question 8

what are the 2 types of oligorthritis

Answer 8

persistent = no more than 4 joints affected

Extended - more than 4 joints affected

Question 9

How to diagnose systemic arthritis

Answer 9

fever - 2 weeks and arthritis of one joint +

• rash
• lymphadenopathy
• hepatomegaly/splenomegaly
• serositis

Question 10

diagnostic criteria of psoriatic arthritis

Answer 10

arthritis and psoriasis or 2 of the following

• nail pitting, onycholysis , psoriasis in first degree relative, dactylisis

Question 11

arthritis that contains the HLA-B27 antigen is..?

Ankylosing spondylitis, sacroiliitis with IBD, and acute uveitis are also features

Answer 11

Enthesitis

Question 12

JIA patterns of onset - oligoarthritic + pauciarticular

= late onset features

Answer 12

negative ANA test

• no extra articular manifestations
• hipe involvement

Question 13

JIA patterns of onset - oligoarthritic + pauciarticular = early onset

Answer 13

• develop uvititis
• positive ANA
• kneads ankles , hands
• doesn’t affect hip

Question 14

polyarticular JIA in seropositive - affects what age?

Answer 14

children over 8

Question 15

polyarticular JIA in seronegative - affects what age?

Answer 15

• more common

- children under 5

Question 16

Polyarticular JIA clinical features and symptoms

Answer 16

temporomandibular joint injury is common

• systemic manifestations are rare - fever, pericarditis, chronic uveitis
• affects large growing joints
• acute onset

Question 17

Enthesitis - related JIA has distinguishing features, name some

Answer 17

onset of apolyarithritis/ oligoarthritis in a boy > 8 years

• HLA-b27 positivity
• acute anterior uveitis
• inflammatory spinal pain
• sacroiliac joint tenderness
• Family History

Question 18

Psoriatic features of onset

Answer 18

HLAb27

• FH psoriasis
• Dactylitis
• onycholysis

Question 19

Investigation for Arthritis

Answer 19

lab

• plain x ray
• ultra sound
• MRI with contrast

Question 20

What is the drug treatment for JIA?

Answer 20

disease modifying anti-rheumatic drugs (DMARDS) –methotrexate

NSAIDS

• intra-articular
  corticosteroid injections

Question 21

non-pharmacological treatment of JIA?

Answer 21

Psychosocial - counselling 
School adjustments
Nutrition - address anaemia and osteoporosis 
- physical therapy
- Occupational therapy

Question 22

Intraarticular steroids(IAS) have greater success in what joint?

Answer 22

Oligoarticular JIA

Question 23

Biological agents that are used?

Answer 23

Anti TNF

Question 24

Uveitis is more common In what arthritis?

Answer 24

ANA positive oligo JIA

- all those diagnosed with JIA will be seen within 6 weeks

Question 25

treatment of uveitis?

Answer 25

slit lamp examination

• topical steroids
• more severe- systemic steroids

Question 26

Complications of JIA? (5)

Answer 26

• Poor growth
• Localised growth disturbances
• Micrognathia
• contractures
• Ocular complications