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Year 4 Paeds- A > Paeds rheumatology > Flashcards

Paeds rheumatology Flashcards

1
Q

JIA definition

A
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2
Q

The key features of inflammatory arthritis are

A

joint pain, swelling and stiffness.

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3
Q

five key JIA subtypes:

A

Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis

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4
Q

Systemic JIA definition and features

A
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5
Q

Systemic JIA investigation findings

A
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6
Q

Key complication of systemic JIA

A
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7
Q

In children that have fevers for more than 5 days, the key non-infective differentials to remember are

A

Kawasaki disease
Still’s disease (systemic JIA)
rheumatic fever
leukaemia.

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8
Q

Polyarticular JIA deifntion and features

A
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9
Q

Polyarticular JIA is the equivalent of … in adults

A

rheumatoid arthritis

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10
Q

Polyarticular JIA investigation findings

A
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11
Q

Oligoarticular JIA definition and presentation

A
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12
Q

Oligoarticular JIA investigation findings

A
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13
Q

Juvenile psoriatic arthritis definition and presentation

A
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14
Q

Juvenile psoriatic arthritis is associated with several signs on examination:

A
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15
Q

Enthesitis-related arthritis is more common in

A

male children over 6 years

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16
Q

Enthesitis-related arthritis is the paediatric version of the… group of conditions that affect adults

A

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.

17
Q

The majority of patients with enthesitis-related arthritis have the… gene

A

The majority of patients with enthesitis-related arthritis have the HLA B27 gene

18
Q

When assessing patients for enthesitis-related arthritis, consider signs and symptoms of

A

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.

19
Q

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:

A
20
Q

Management of Juvenile Idiopathic Arthritis

A
21
Q

Enthesitis definition and cause

A
22
Q

…criteria is used to assess the probability of septic arthritis in children using 4 parameters:

A

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

23
Q

Red flags in MSK symptoms

A
24
Q

Features to suggest not growing pains

A
25
Q

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:

A

Synovitis or arthritis of the right knee
–> juvenile idipathic arhtirit

26
Q

Differential diagnosis of a swollen joint

A
27
Q

Diagnosis of JIA

A
28
Q

Benign joint hypermobility syndrome management

A

Disease education
Pens, OT help with writing
Exercises for muscle control of joints
Advice to continue sports

29
Q

Benign joint hypermobility syndrome differentials and what conditions are associated with this

A
  • 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)
30
Q

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.

A

Systemic JIA

31
Q

Common differential diagnosis for systemic JIA

A

ALL
Neuroblastoma
Sepsis/Infection
Reactive illness
Kawasaki disease

32
Q

Manifestations of Kawasaki disease

A
33
Q

Kawasaki disease investigations and management

A

Year 4 Paeds- A (15 decks)

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