Peds: Rheumatology

Question 1

What is juvenile rheumatoid arthritis?

Answer 1

arthritis involving pain, swelling, warmth, tenderness, morning stiffness

decreased ROM of one or more joints lasting at least 6 weeks

Question 2

What are some associated systemic manifestations of juvenile rheumatoid arthritis?

Answer 2

fever

rash

uveitis

serositis

anemia

fatigue

Question 3

What is the most common type of juvenile rheumatoid arthritis?

Answer 3

oligoarticular

Question 4

What is oligoarticular JIA and which joints does it affect?

Answer 4

arthritis of four or fewer joints

affects medium to large joints

Question 5

What are some S/S of oligoarticular arthritis?

Answer 5

arthritis is often asymmetric

leg-length discrepancy

synovitis

insidious asymptomatic uveitis

Question 6

What is polyarticular arthritis and which joints are affected?

Answer 6

arthritis involving 5 or more joints

large & small joints are involved

Question 7

What are some S/S of polyarticular arthritis?

Answer 7

arthritis is often symmetrical

low-grade fever

fatigue

rheumatoid nodules

anemia

Question 8

What is systemic arthritis?

Answer 8

may involve any number of joints

affects both large & small joints

Question 9

What are the classic features of systemic arthritis?

Answer 9

high fever (39-40ºC) typically ocurring 1-2 times/day

characteristic evanescent, salmon-pink macular rash that is prominent on pressure areas & when fever is present

Question 10

What is enthesitis-associated arthritis?

Answer 10

typically associated w/ lower extremity, large joint arthritis

most common in males older > 10 yrs

Question 11

What is the hallmark S/S of enthesitis-associated arthritis?

Answer 11

inflammation of tendinous isnertions (such as the tibial tubercle or heel)

Question 12

What are some S/S of psoriatic arthritis?

Answer 12

subtle nail changes such as nail pitting

dactylitis (sausage digits)

uveitis

Question 13

What is undifferentiated JIA?

Answer 13

children w/ chronic arthritis that do not meet criteria for the other groups

Question 14

What is the treatment for JIA?

Answer 14

goal is to restore function, relieve pain, maintain joint motion

NSAIDs- first line

methotrexate- second line

local steroid injections for 1 or fewer joints

Question 15

What are some complications of JIA?

Answer 15

mostly MSK related

contractures - difficulty walking

positive RF = worse prognosis

Question 16

What is systemic lupus erythematus?

Answer 16

multisystem inflammatory disease of the joints, serial linings, skin, kidneys, blood, central nervous system

Question 17

What is positive in almost 100% of patients with SLE?

Answer 17

ANA

Question 18

What are some S/S of SLE?

Answer 18

malar rash (butterfly rash)

discoid rash (annular)

photosensitivity

mucous membrane ulcers

renal abnormalities

raynauds

lymphadenopathy

serositis

neuro abnormalities

blood count abnormalities

Question 19

What is the mainstay of treatment for SLE?

Answer 19

prednisone

Question 20

What is the most common type of small vessel vasculitis in children?

Answer 20

Henoch-Schonlein purpura

Question 21

What are the typical S/S of Henoch-Schonlein purpura?

Answer 21

purpuric cutaneous rash

migratory polyarthritis or polyarthralgias

intermittent ab pain

nephritis

Question 22

To diagnose Henoch-Schonlein purpura, the patient must have 2 of the 4:

Answer 22

purpura

bowel angina

biopsy

pediatric group

Question 23

Besides the skin, what other organ systems can Henoch-Schonlein purpura?

Answer 23

GI tract

kidneys

deposition of IgA immune complexes

Question 24

What is the treatment for Henoch-Schonlein purpura?

Answer 24

generally supportive

NSAIDs-may help with arthritis

corticosteroid therapy for symptomatic relife