RHEUM Flashcards
IDIOPATHIC JUVENILLE ARTHRITIS
<16
Intermittent fever + daily transient MP rash usually with fever serositis hepato/splenimegaly labs: thrombocyttosi + leukocytosis , anemia , lymphadenopathy
list types of athriits
REACTIVE
PSORIATIC
JUVENILLED IDOPATHOC
SEPTIC
osteo - not relevant to kids
how can we classify arthritis
acute and chronic
cut off point for chronic arthitis
6 weeks
what/how many fetaures must be presnet for someone to have arthritis
2 of the features of arthitis OR INTRARTICULAR EDEMA
HOW long should morning stiffness be to be clincally relevant
> 10 minutes
what cardinal sign of inflammation isn’t really typical for juvenille RA
RUBOR - so if it is then suspect septic of acute rheumatic fever
what key featureS between RA in kids and septic
septic- won’t be able to weight bear AT ALL
RA- tolerable, they will still get on with their day
sep: dramtic onset within hours/das
ra:more chornic in nature
sep: LOOK ILL_ redness over skin
RA: look fine + skin not red
sep; usually 1 joint!
night time sympotms in RA
no no no think cancer and bening too like osteoriod osteoma
which cancers are we thinking bone pain
leukemia and bone cancer
what is quite relevant in the history of a kid with RA
usually will have a family history of Autoimmune conditions like chornes or diabtes
chronic osteomyelitis
imgaing for OM
draining sinus tact
mri is amazing for bone
x ray - too ealry to see
WHAT things should a person NOT HAVE ON PHYSICAL EXAM for Ra
Red joints
fever - unusual?
HSM?- double chek on vn usman
general lymphadenopathy
how can the eyes become affected in RA
most common location of OM
anterior uveitis - iridicycltiis with formation of syechia which means pupils don’t respond to light
long bones like femur and tibia
labs for ra
leukocytes should either be normal or high (if low suspect dx)
plt- normal or high - remember plt are a very sensitive pro inflammatory marker
neutrohilia
SHOULD NOT BE LYMPHOCYTOSIS dx leukemia
CRP + ESR (but remember crp is very acute so if this is a chronic or latent phase it can be normal )
dx for RA
immunodeficiency - because that can cause joint pain and fevers and also because of the treatment! it is contradictory, for RA we need to immunosuppression but we cant give that to a deficient person.
hemophilia - espcially if its a boy who is just starting to walk - do a clotting screen
why do we think about ANA IN RA
because ANA + girls are risk for uveitis so we need to regularly asses every 3 months
ANA - (not such a risk )
what imaging if you suspesct RA which is best
X RAY- need to rule out ewing sarcoma, and other bone cancers like sarcomas esp if its MONOARTCICULA
ultrasoinf of the joint- effusions and synovial hypertoophy
us is best because x ray changes will only be seen after 10 DAYS! osteopenia and reduced joint space !
key buzzwords for RA
osteomyleitis tx
SYNOVIAL HYPERTROPHY
JOINT EFFUSION
INTRA ARTICULAR EDEMA
IV ab for several weeks(until labs are good ) then after swithc to oral fore several weeks
TX RA
CS
-intrarticular if oligo
- iv - if poly
methotrexate -dmards- once a week (remember folic acid)
biolgical therapy
- anti IL-6
ANTI TNF
DEF oligoarthtis
cause of osgood chatlet and signs
<4 joints or 4
osteochrondrtis of patella tendon
pain after exertion and some will have tibual tuberosity swelling
why are we wary of cs
tx of oscgood shatle
because of stunted growth iTS VERY DIFFCULT FOR KIDS TO CATCH UP and the plethora of side effects
physi to strenghten quads, immobilizd
what is the problem with physical exam of septic arthtis in regards to inflammaiton
some of the features will not be vsisable if tis a deep joint like the hip like redness and edema as joint is too
tx for septic
complicatins of SEPTIC ARTHTIRIS
IV! 2 different ones - antistaph drugs
blood cultres
osteomyelitis
osteonecrosis (espcially hip and shoulder joints as head of femur the vessels cant supply blood due to the high pressure so need to make sure you drain joints to decrease the risk of necrosis
most common cause of septic
transiet coxitis tx
STAPH
More frequently boys up to 4(8) yrs. of age, often following URTI. Well child, afebrile or sub-febrile
Limp but able to bear weight with limited internal rotation and extension
rest and nsaids THERE CAN BE EFFUSIONS! so drain
leukemia vs juvanelle
leukemia can have low lymphocyes!
night pain = leukmia
high LDH
physical exam look unwell
leukemia HSM+ LYMPHADENOPATHY
lekmeia on physcial exam usally no evidence of arthritis
joint aspirationc an rule out
FAMILIAL MEDITTERRANEAN FETAURES, epidemiology and what would you calsfifcy the illness under
infection and maliganancy!
AR,
fever, serositis(PAINFUL perionitis, painful chest) arthritis (lower limbs) rash (erysipelas like) , orchitis in between attacks its calm and self remitting
colchine to prevent amyloidosis
jews, turks armeians
its an autoinflammotry disorder (no immune vibes foind)
Complications of RA
perthes disease , diagnosis , DX , tx
flexion contractures - will need physio and splinting
joint destruction- may need a prosthesis to repair the joint
anterior uveitis
boys, limp, referred pain to the knee , can result in deformaties! And the child may need to have a splint to keep immbolized
D: x ray - SCLEROIS
tx: <50% comservative, bed rest, no weight bearing
>50% splint, or osteotomy (cut and reshape bone)
DX - transiet synovitis as same symptoms but will resolce in 2 weeks, perthes disease is more chronic
slipped capital epihysis , x ray fetaures
Dislocation of the epiphysis of the femoral head posteriorly and inferiorly
Overweight boys aged 10-14 yrs (more teens)
Associated with hypothyroidism and growth hormone deficiency Diagnosed radiographically; bilateral in 30%
Treatment – urgent referral to orthopedics – in the meantime non-weight bearing, immobilization to prevent avascular necrosis, surgery to fix the epiphysis in place with a SCREW
postive trendelenberg
x ray - widened epihysis, trethowans sign
osteoid osteoma
night time pain, most commonly proximal femur and radiates to the knee!
tx, nsaids and surgery to remove
x ray- area of lucency surrounded by sclerosis
key word for ex ray leukemia
main rf for oschgood schatler
lucent metaphyseal bands!!
young active boys who play sports
osteochondritis descinas
pain from avascular necorsis of femoral medial condyle causinf bone and caritalge to seperate
common in girls
physio to streghtne the quads, and rest
chonadromalcia patella
common in girls
softenign of patella cartialge
difficut to walk up the stairs and stand from sitting up
physio to streghent the quads
gworing pains
doesnt affect mobilty
from 3-12
symmterical pain in lower limbs
NEVR HAPPENS IN THE IN THE MORING WHEN YOU WAKE UP
nomral physical exam
