Paeds rheumatology Flashcards
JIA definition
The key features of inflammatory arthritis are
joint pain, swelling and stiffness.
five key JIA subtypes:
Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis
Systemic JIA definition and features
Systemic JIA investigation findings
Key complication of systemic JIA
In children that have fevers for more than 5 days, the key non-infective differentials to remember are
Kawasaki disease
Still’s disease (systemic JIA)
rheumatic fever
leukaemia.
Polyarticular JIA deifntion and features
Polyarticular JIA is the equivalent of … in adults
rheumatoid arthritis
Polyarticular JIA investigation findings
Oligoarticular JIA definition and presentation
Oligoarticular JIA investigation findings
Juvenile psoriatic arthritis definition and presentation
Juvenile psoriatic arthritis is associated with several signs on examination:
Enthesitis-related arthritis is more common in
male children over 6 years
Enthesitis-related arthritis is the paediatric version of the… group of conditions that affect adults
the paediatric version of the seronegative spondyloarthropathy group of conditions that affect adults. These conditions are ankylosing spondylitis, psoriatic arthritis, reactive arthritis and inflammatory bowel disease-related arthritis. Patients have inflammatory arthritis in the joints as well as enthesitis.
The majority of patients with enthesitis-related arthritis have the… gene
The majority of patients with enthesitis-related arthritis have the HLA B27 gene
When assessing patients for enthesitis-related arthritis, consider signs and symptoms of
psoriasis (psoriatic plaques and nail pitting) and inflammatory bowel disease (intermitted diarrhoea and rectal bleeding). Patients with enthesitis-related arthritis are prone to anterior uveitis and should see an ophthalmologist for screening, even if they are asymptomatic.
Patients with enthesitis will be tender to localised palpation of the entheses. Therefore it is worth palpating key areas to elicit tenderness of the entheses:
Management of Juvenile Idiopathic Arthritis
Enthesitis definition and cause
…criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr
The probabilities are calculated thus:
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis
Red flags in MSK symptoms
Features to suggest not growing pains
4 year old boy
Limp and knee swelling for 8 weeks:
reduced play
stiff in mornings
Otherwise well, good appetite, no fever, no pain at night
On examination: all joints fine except knee:
Synovitis or arthritis of the right knee
–> juvenile idipathic arhtirit
Differential diagnosis of a swollen joint
Diagnosis of JIA
Benign joint hypermobility syndrome management
Disease education
Pens, OT help with writing
Exercises for muscle control of joints
Advice to continue sports
Benign joint hypermobility syndrome differentials and what conditions are associated with this
- Need to rule out associated inheritable conditions e.g. Marfan’s syndrome
- Ehler’s Danlos syndrome type 3: Other types including life-limiting type 4 (spontaneous vascular accidents)
3 year old girl
Fever, decreased appetite, miserable
Very unwell when hot with transient pink rash
Admission to hospital:
* IV antibiotics
* Full septic screen (? what)
* Swollen knee, ankle and fingers noted
Fever pattern emerged over a few days to a once a day spike (quotidian). No suggestion that fever stopping with antibiotics.
Systemic JIA
Common differential diagnosis for systemic JIA
ALL
Neuroblastoma
Sepsis/Infection
Reactive illness
Kawasaki disease
Manifestations of Kawasaki disease
Kawasaki disease investigations and management
