Pediatric Rheuma From www.rheumatology.com Flashcards
A four year-old white female is brought to your office because her mother says, for the last two months, she has limped every morning for about an hour, which eventually improves. She has had no fevers or rash. On your exam, she is happy and playful but walks with a limp. She has swelling of her left knee and left ankle. Her CBC, ESR, and CRP are normal. Her rheumatoid factor, anti-CCP antibodies, and Lyme studies are negative. She has an ANA that is positive at 1:160
Diagnosis?
JIA
Differential Diagnosis of Patient with JIA:
Patient with significant joint swelling, especially of the knee
Lyme Arthritis
Differential Diagnosis of Patient with JIA:
not associated with a morning preponderance of symptoms
Trauma
Differential Diagnosis of patient with JIA:
With more acute in presentation and be associated with more systemic symptoms;
Septic Arthritis and Osteomyelitis
Differential Diagnosis of patient with JIA:
________________ , such as pediatric lupus, juvenile dermatomyositis or systemic vasculitis, which would have more extraarticular features
Systemic Autoimmune Disease
Differential Diagnosis of patient with JIA:
Non-_________ causes of joint pain, including slipped capital femoral epiphysis and idiopathic avascular necrosis, which would be associated with activity-related pain, rather than morning stiffness.
inflammatory
Significance of :
- Negative RF
- Negative anti-CCp Ab
- Normal inflammatory markers
More aggressive course
JIA patients with just a few joints affected often have normal inflammatory markers
Major commorbidity with JIA
Uveitis
Significant Risk Factors for UVEITIS:
_____ gender
_____ age
RF ____
recent development of disease
Significant Risk Factors for UVEITIS:
Female gender
Young age
RF Positive
recent development of disease
Patients with ENTHESITIS related arthritis get acute uveitis, characterized as:
Red, Painful, Photophobic eye
Patient with Systemic JIA, with fever altered mental status, Transaminitis and Pancytopenia
Macrophage activation syndrome
most sever complication of sJIA
Laboratory hallmarks of MAS:
Hyperferritinemia Cytopenia Transaminase \_\_\_\_\_\_\_\_ Paradoxically \_\_\_\_ or \_\_\_\_\_ ESR \_\_\_\_\_\_ Triglycerides \_\_\_\_\_\_\_\_\_\_\_ PT and PTT
Hyperferritinemia Cytopenia Transaminase elevation Paradoxically low or normal ESR Elevated Triglycerides Prolonged PT and PTT
You get called to a consult in the ED because there is a nine year-old Latino male who has a red raised rash on his legs and buttocks. When you see him, you also notice that his knee is swollen, but he seems to be walking without difficulty. Otherwise he looks happy and well. His CBC, ESR, and coagulation studies are normal.
HSP
IgA mediated vasculitis
Histologic Features of HSP
Leukocytoclasis
-vascular damage caused by nuclear debris form infiltrating neutrophils
IgA deposition
Major clinical manifestion of HSP:
Tetrad
- Purpura
- Arthritis
- GI involvement
- Renal involvement
