Paeds Rheumatomolgy Flashcards
DDx of limp/joint pain toddler 1-3 yrs
Transient synovitis Juvenile Arthritis Trauma Growing pain Child abuse Developmental dysplasia of the hip Malignancy Neuromuscular disease Referred pain Haemophilia Henoch schoenlein purpura Autoimmune
DDx of limp/joint pain child 4-10 yrs
Transient synovitis Juvenile arthritis Trauma Growing pain Perthes’ disease Rheumatic fever Associated with IBD Malignancy Referred pain Haemophilia Henoch-Schoenlein purpura Autoimmune
DDx of limp/joint pain adolescent 11-16 yr
Slipped upper femoral epiphysis Juvenile arthritis Trauma Mechanical(hypermobility) Associated with IBD Malignancy overuse syndromes Autoimmune
points to consider while Hx taking in joint pain in kids
Age Mode of onset (acute or insidious) Any previous episodes of joint pain Current or preceding illness or injury Location, pattern, and duration of pain Joint swelling, fever Recent travel
benign symptoms of joint pain in kids
Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia
benign signs of joint pain in kids
Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia
red flag symptoms suggestive of serious conditions in kids joint pain
Fever
Malaise/lethargy
Morning joint stiffness or pain
Night pain refractory to simple analgesia and symptomatic during the daytime
red flag signs suggestive of serious conditions in kids joint pain
Joint swelling
Bony tenderness to palpation
Muscle weakness
Fall in height or weight growth curve
investigations of joint pain in kids: bloods
Raised WBC and Neutrophils
ESR Elevated 48 hours after the inflammation
Sensitivity high
CRP Elevated 6 hours after inflammation
Blood film: Normal film does not exclude malignancy-
bone marrow aspirate required
Blood cultures: 46-80% osteomyelitis
22-50% septic arthritis
investigations of joint pain in kids
plain radiography USS MRI bone scan CT
USS in joint pain in kids
sensitive in detecting joint effusions
absence of effusion makes septic arthritis unlikely
MRI in joint pain in kids
very sensitive in detecting early osteomyelitis, Perthe’s, inflammatory disease and malignancy
bone scan in joint pain in kids
very sensitive in identifying early osteomyelitis
CT in joint pain in kids
useful to detect early bone changes and tumours, early fractures.
Significant exposure to ionizing radiation
septic arthritis/osteomyelitis in kids: features
fever
systemic upset
severe limitation of joint movements
beware of subtle presentation
septic arthritis/osteomyelitis in kids: investigations
FBC CRP ESR USS and guided aspiration X-ray
septic arthritis/osteomyelitis in kids: managemen
urgent ortho input
may need joint washout and IV antibiotics
joint trauma in kids: features
history of trauma
signs of injury
joint trauma in kids: investigations
x-ray/CT
joint trauma in kids: management
in or outpatient depending on the cause and type
irritable hip in kids: features
systemically well
irritable hip in kids: investigations
FBC
CRP
ESR
irritable hip in kids: managment
advise regular analgesia for 48 hrs
follow up in 7-10 days
Henoch-Schoenlein purpura: features
purpuric rash
abdo pain
haematuria
Henoch-Schoenlein purpura: investigations
urine dipstick and microscopy
BP
Henoch-Schoenlein purpura: management
paeds referral and follow up
haemarthrosis: features
if spontaneous or after minor injury consider haemophilia
haemarthrosis: investigations
coagulation studies
haemarthrosis: management
if clotting abnormal paeds referral
rheumatic fever: features
carditis erythema marginatum mograting polyarthritis subcut nodules chorea
rheumatic fever: investigations
ECG/ECHO FBC U+E CRP ESR ASOT DNase B
rheumatic fever: management
refer to paeds
serum sickness: features
hx of medication use
rash
serum sickness: investigations
FBC U+E CRP ESR ASOT DNase B
serum sickness: management
follow up in 7-10 days
reactive arthritis: features
hx of recent viral illness
well child
reactive arthritis: investigations
exclude septic arthritis
reactive arthritis: management
follow up in 7-10 days
JIA DDx medical
Septic arthritis Reactive arthritis Rheumatic fever Associated with IBD Connective tissue disorder: (Systemis Lupus,Juvenile Dermatomyositis, Connective tissue disorder) Mechanical joint pain(hypermobility) Growing pain
JIA DDx malignancy
leukaemia
neuroblastoma
primary bone tumour
JIA DDx surgical
Perthe's disease Slipped upper femoral epiphysis Congenital hip dysplasia Fracture Trauma Referred pain
management of JIA
Encourage normal activity Drug treatment Regular ophthalmology review for uveitis screening. Physiotherapy, including hydrotherapy Occupational therapy Psychology Family School / peer group
poor prognostic factors in JIA
Active disease at 6 months Polyarticular onset and course Extended oligoarticular Female Rh Factor +ve ANA +ve Persistent raised inflammatory markers
complications of JIA
Altered growth of limbs Scoliosis Short stature Joint damage / destruction Blindness(untreated uveitis) Psychosocial effects of chronic disease Loss of schooling
