Rheum

Question 1

What is Juvenile Idiopathic Arthritis?

Answer 1

A condition that presents with autoimmune inflammation within joints

Question 2

What criteria are needed for a diagnosis of JIA?

Answer 2

Arthritis >6/52 without another cause in a patient under 16y

Question 3

What are the different subtypes of JIA?

Answer 3

Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Juvenile Psoriatic Arthritis

Question 4

What is Systemic JIA also known as?

Answer 4

Stills disease

Question 5

What are symptoms of Stills disease (Systemic JIA)?

Answer 5

Salmon Pink rash
Enlarged lymph nodes
Weight loss
High swinging fevers
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritis
Pericarditis

Question 6

What may bloods demonstrate in Stills disease?

Answer 6

ANA -ve
Rh Factor -ve
Raised Inflammatory markers

Question 7

What are some complications of Stills disease?

Answer 7

Macrophage Activation Syndrome - Severe immune system activation with an inflammatory response

Question 8

What is Polyarticular JIA?

Answer 8

Disease involves >5 joints

Often symmetrical, equivalent of RA in adults

Question 9

How does Oligoarticular JIA present?

Answer 9

Disease involves <4 joints, usually presents as a monoarthritis

Question 10

Which condition is strongly linked to Oligoarticular JIA?

Answer 10

Anterior Uveitis

Question 11

What is Juvenile Psoriatic Arthritis associated with?

Answer 11

Psoriasis

Question 12

How can JIAs be managed?

Answer 12

NSAIDs - Ibuprofen
Steroids - PO, IM or intra-articular
DMARDs - Methotrexate, Sulfasalazine
Biologic Therapy - TNF alpha inhibitors - Infliximab

Question 13

What is Henoch-Schoenlein Purpura?

Answer 13

IgA vasculitis that presents with a purpuric rash of the lower limbs and buttocks.

Question 14

What are some classical features of Henoch-Schoenlein Purpura?

Answer 14

Purpura
Joint Pain
Abdominal Pain
Renal Involvement

Question 15

What are some potential differentials for suspected HSP?

Answer 15

Meningococcal Septicaemia
Leukaemia
Idiopathic Thrombocytopenic Purpura
Haemolytic Uraemic syndrome

Question 16

Which investigations are appropriate for suspected HSP?

Answer 16

FBC + Blood film
Renal profile
Serum albumin
CRP/Cultures
Urine dip
Urine PCR
BP - ?HTN

Question 17

What are the diagnostic criteria for HSP?

Answer 17

Palpable Purpura

AND ANY ONE OF:

Diffuse abdominal pain
Artthritis/Arthralgia
IgA deposits on Biopsy
Proteinuria/Haematuria

Question 18

How should confirmed HSP be managed?

Answer 18

Supportive - Analgesia, Rest, Hydration
?Steroids if severe
Repeated Urine Dip and BP

Question 19

What are potential complications of HSP?

Answer 19

Recurrence within 6m

ESRD - Minority

Question 20

What is Kawasaki’s Disease?

Answer 20

Systemic, medium-sized vessel vasculitis

Question 21

Which age group is typically affected by Kawasaki’s disease?

Answer 21

Under 5y

Question 22

What are common clinical features of Kawasaki’s disease?

Answer 22

Persistent High Fever >39 for more than 5 days
Widespread erythematous maculopapular rash
Desquamation of the palms and soles
Strawberry tongue
Cracked lips
Cervical Lymphadenopathy
Bilateral conjunctivitis

Question 23

Which investigations are appropriate for suspected Kawasaki’s Disease?

Answer 23

FBC
LFTs
Inflammatory markers
Urinalysis
Echo - ?Coronary Artery Aneurysms

Question 24

What is the recommended management of confirmed Kawasaki’s Disease?

Answer 24

High Dose Aspirin - Reduce thrombosis risk

IV Immunoglobulin - Reduce risk of Coronary Artery aneurysm