Rheum Lecture

Question 1

Systemic
Polyarthritis
Oligoarthritis
Enthesitis-related
Psoriatic

Answer 1

Subtypes of Juvenile Idiopathic Arthritis

Question 2

NSAIDs
Corticosteroids
Methotrexate, Hydroxychloroquine, Sulfasalazine
Etanercept, Infliximab

Answer 2

Tx options for juvenile RA

Question 3

Need 2 of the 4 for a diagnosis:

Purpura
Bowel angina
Biopsy
Peds group

Answer 3

Henoch Sholien Purpura

Question 4

Criteria for dx:

Fever
plus 4 or 5 of:

Conjunctivitis
Mucus membrane
Extremities
Rash
Adenopathy

Answer 4

Kawasaki Disease

Question 5

Malar rash
Photosensitivity
Discoid lupus
Renal signs
Raynauds
Mucosal sores
Lymphadenopathy

Answer 5

SLE

Question 6

Tx:
Corticosteroids
NSAIDs
Hydroxychloroquine
Cyclophosphamide
Counseling

Answer 6

Tx for SLE

Question 7

ANA

DS DNA

Complement

..used for the dx of?

Answer 7

SLE

Question 8

Females > males
onset either 2-5 or 10-14 (bimodal age distribution)

Usually starts with 1-2 joints
Spreads to about 5 joints within 6 months

• *symmetric joint involvement** (knees, wrists, ankles)
• *dactylitis, uveitis**

Dx: must have arthritis in 4 or more joints within 6 months and rule out other causes

Answer 8

Polyarhritis juvenile arthritis

Question 9

arthritis and enthesitis, or arthritis and 2 of:
-SI joint tenderness
-inflammatory spinal pain
-HLA B27
-Fam hx of anterior uveitis with pain,
spondyloarthropathy, or IBD
-Anterior uveitis with pain, redness or
photophobia

Answer 9

Ethesitis-related juvenile arthritis

Question 10

Which NSAID should be avoided in kids?

Answer 10

Aspirin!

Question 11

Girls preschool age (rare under age 1)

Arthritis in less than 5 joints. Maybe single joint (knee, ankle, wrist, hands)

DIP arthritis= highly indicative

Psoriatic so will see associated soft plaque rash

Skin and nails (pitting of nails)

Onchyolysis (nails separate from nailbed)

Uveitis

Answer 11

Psoriatic juvenile arthritis

Question 12

Presentation can be articular or extraarticular
Usually wrists, knees, ankles (but can be others)

Fevers! Quotidian fever..high intermittent fevers almost daily

Rash associated with heat/fever (often axilla, waist)
-can elicit rash if you rub the skin (bc of warmth)

Hepatosplenomegaly, lymphadenopathy
VERY high WBC!
Thrombocytosis (high platelets)
Anemia

Complications= joint destruction. can affect growth, may have early replacement surgery, fusions, etc.

Answer 12

Systemic juvenile arthritis

Question 13

Can be extended or persistent
Limp without pain
No systemic signs
Affects larger joints

Joints may be swollen, tender on exam (no erythema)

Answer 13

Oligoarthritis

Question 14

Small/medium artery involvement
aneurysm formation

High fevers!!
Conjunctivitis, rash, strawberry tongue, dry cracked mucosa, cervical LAD
Tachycardic, SOB, CHF symptoms
Skin on fingers and toes “slough”

High risk of sudden death! Coronary artery anuerysm

Answer 14

Kawaski disease

Question 15

Tx for Kawasaki Disease?

Answer 15

IV Ig (can also give Aspirin)