RHEUM

Question 1

If a child has continuous knee pain, with no trauma or history to explain it, what diagnosis should you keep on your differential?

Answer 1

Juvenile Idiopathic Arthritis

Question 2

What diagnostics would you start with for your child with continuous idiopathic bone or knee pain?

Answer 2

CBC, ESR, CRP, x-ray, rheumatoid factor, ANA, aspirate a joint effusion

Also check the eyes! Uveitis = rheumatologic condition

Question 3

What are the subtypes of JIA?

Answer 3

Systemic arthritis, polyarthritis, oligoarthritis, enthesitis-related arthritis, and psoriatic arthritis

Question 4

Articular findings are in the joint(s) themselves, what are extra articular presentations of systemic JIA?

Answer 4

Fevers (quotidian = high spiking fevers that comes and goes almost daily); macular salmon pink rash (often associated with the fever – look in the axilla & waist, you can illicit the rash with koebner), hepatosplenomegaly, and lymphadenopathy

Question 5

What would the labs look like on systemic JIA?

Answer 5

super high WBC counts, thrombocytosis, anemia, usually negative ANA & rheum factor

Question 6

What is a significant complication of systemic JIA, including spontaneous bleeding, bruising, seizures, and coma?

Answer 6

Macrophage activation syndrome

Question 7

What type of JIA is more common in females, has a bimodal are distribution (young & old), and has symmetric multiple joint involvement, dactylitits, and pain out of proportion to exam?

Answer 7

Polyarticular JIA

Question 8

How many joints must be involved in order to diagnose polyarticular JIA?

Answer 8

> 4 joints within 6 months of onset

Question 9

What type of JIA has a persistent (no more than 1 joint involved after 6 months) or extended presentation (less than 4 joints in first 6 months, no more than that), with no erythema of systemic signs and symptoms?

Answer 9

Oligoarthritis

Question 10

How do you diagnose oligoarthritis?

Answer 10

less than 4 joints in first 6 months; if 1 joint must be present for 3 months

Question 11

What form of JIA involves inflammation of the tendons in the joint?

Answer 11

Enthesitis

Question 12

What gene is strongly related to Enthesitis?

Answer 12

HLA-B27

Question 13

What form of JIA is asymmetric, in the lower extremities, and often appears like the child had a sprain that isn’t healing?

Answer 13

Enthesitis

Question 14

What type of JIA is often associated with joint pain in the DIP joint or the axial skeleton along with the skin and nails involved?

Answer 14

psoriatic arthritis

Question 15

What do we look for in the nails with psoriatic arthritis?

Answer 15

pitting of the nails & onycholysis

Question 16

In general, how do we treat juvenile idiopathic arthritis?

Answer 16

NSAIDS! (no aspirin)
corticosteroids (intraarticular)
DMARDS = methotrexate
PT/OT

Question 17

If a child presents with purpuric rash (small vessel inflammation) on the lower extremities, glomerulonephritis, arthralgia, and edema. They also have GI discomfort. What diagnosis?

Answer 17

Henoch Sholien Purpura

Question 18

What labs would you do with Henoch sholien purpura?

Answer 18

Non-thrombocytopenia purpura (platelets are normal or slightly high)

Check urine for hematuria

Question 19

What rheumatologic disorder is associated with aneuryms, seen in Asian children?

Answer 19

Kawasaki

Question 20

What are the phases of Kawasaki?

Answer 20

Acute = high fever, conjunctivitis, cracked lips/strawberry tongue, rash in the inguinal area, and cervical lymphadenopathy, extremity edema, even cardiac involvement (must have 4/5 of these)

Subacute = Sed rate is prolonged; aneurysms (very high risk for sudden death)

Convalescent = disappearance of sxs over 6=8 weeks

Question 21

What diagnostics would we do for Kawasaki?

Answer 21

Urine, blood cultures, angiography, echo

Question 22

How do you treat Kawasaki?

Answer 22

IV Ig

Question 23

If a child has a malar rash, axillary lymphadenopathy, proteinuria, raynauds, and mucosal sores – what diagnosis?

Answer 23

SLE

Question 24

How do you diagnose SLE?

Answer 24

ANA, dsDNA, and low complement (C3, C4)

Check the urine!

Question 25

How do you treat SLE?

Answer 25

Corticosteroids