Pediatric Rheumatology Flashcards
signs and symptoms of arthritis
swelling, warmth and redness, pain, decresed joint space, decreased range of motion, decreased function, poor development of joint
- overall impact on physical, emotional and social growth and maturity
ddx of juvenile inflammatory arthritis
- septic arthtiris
- osteomyelitis
- chronic non-infectious osteomyelitis
- post-infectious arthritis (◦ Rheumatic fever
◦ Post-streptococcal arthritis
◦ Reactive arthritis
◦ TB associated arthritis
◦ Lyme disease) - arthritis associated with other conditions (malignancy, hemophilia, IBD)
- mechanical/orthopedic conditions
- metabolic/genetic disorders
juvenile arthritis is not a single disease. what are the subtypes of juvenile idiopathic arthritis?
describe the 7 subtypes of juvenile idiopathic arthritis in terms of frequency, age of onset and sex.
(systemic, oligoarticular, rf +, rf-, enthesitis related, psoriatic, undifferentiated)
common presentation of oligoarticular arthritis
- female
- elbow, knee, wrist, ankle involvement
Arthritis in 1-4 Joints in first 6months
After 6 months of symptoms
Persistent – 4 or fewer during disease course
Extended -More than 4 joints cumulatively after 6m
- uveitis/eyeproblems (usually asymptomatic)
which gender does oligoarticular arthritis affect more?
3:1 female to male.
uveitis/iritis seen in oligoarthritis JIA
Asymptomatic Pupillary asymmetry Cataracts Band keratopathy Blindness Requires routine
screening, frequency
determined by ANA
common presentation off rF NEGATIVE JIA
- jaw, bilateral knees, elbows, ankle (more symmetrical than oligoarthritis). arthritis 5> joints within first 6 months.
- has a bimodal peak: 1-3 years and then early adolescnece.
- 3:1 female: male
- affects large and small joints
- if they are ANA positive, there is an increased risk for uveitis
what increases the likelihood of someone with JIA having uveitis?
Ana postiive
children with poly-JIA RF negative often have painless ___ in whcih the fingers cant lay flat on the bed, some fingers with a 90 degree angle. sometimes they may need surgery or splinting.
contractures.
common presentation of rF positive polyarticular JIA
patients are usually a bit older/adolscent
common presentation of systemic JIA
the evanescent erythematous rash is usually salmon colored, macular, urticaria-like.
- it is non scarring and can appear with fever spikes.
other systemic JIA features includes pericardidits, pleural effucions, macrophage activating syndrome.
common presentation of psoriatic JIA
arthritis and psoriasis
OR
arthritis, dactylitis, nail pitting and onycholysis and psoriasis of a first degree relative.
- exclusion: artheritis in B27 positive after 6th bday, or presence of systemic JIA.
typical psoriatic patient (peds)
2 year old patient with swolled 2nd finger, swollen toes, asymmetric joint paint, and irregular nails. parent has a history of red scaly rash on extensor sufaces.
common presentation of enthesitis-related JIA
teenage boy
- affects achilles, knees, and pelvis
- more likely to have uveitis
HLAb27+, inflammatory lumbosacral pain, sacroiliac joint tenderness.
- exclusion if rF+, or psoriasis
HLAB27 associated diseases
- ankylosing spondylitis
- reactive arthritis (can turn chronic)
- rheumatoid arthritis
- enthesitis related arthritis
- sacroilitius with IBD
undifferentiated psoriatic JIA
a JIA that does not fulfill criteria of other categories but meets criteria for more than one subtype
ex/ psoriatic arthritis in HLAB27+ boy, when HLAB27 isn’t really associated with PA as much as it AS (which mainly affects boys)
common treatments of JIA
juvenile dermatomyositis
derma-skin
myositis= inflammation of the muscle
- symmetrical proximal muscle weakness with skin rash
Median age in pediatric population is 7yr
diagnosing dermato myositis
- rash
- systemic proximal muscle weakness
- lab: muscle breakdown products like AST, ALT, CPK/CK, LDH
- muscle biopsy and look for muscle edema
- EMG
heliotrope; erythema of the eyelids associated with JDM
which joints are most affected by gottrons papules
gottrons papules are papulosquamous-erythema over joints. looks like eczema.
DIP and MCP and extensor surfaces affected
nail fold capillary manifestations of JDM
- dilated, tortuous drop-out and hemorrhagic cuticles.
