Rheum- Peds

Question 1

Juvenile idiopathic arthritis (JIA)- pathophysiology

Answer 1

<16 yo involving at least 1 joint >6w
HLA loci
Joint swelling from synovial fluid inc-
Inflammatory cells + expansion of pannus —> joint damage

Question 2

Juvenile idiopathic arthritis (JIA)- epidemiology

Answer 2

F>M
1-3y 
8-10y 
White 
Less common- AA and Asians

Question 3

Juvenile idiopathic arthritis (JIA)- diagnosis

Answer 3

Clinical- no specific labs or imaging

exclude other possibilities

Question 4

Juvenile idiopathic arthritis (JIA)- treatment

Answer 4

Early the better
Refer Rheum

NSAIDs - IB, naproxen, meloxicam
Intrarticular joint injections - triamcinolone acetate

Some - mauy need DMARD

• Methrotrexate - aggressive w/ seropositive
• Biologics - infliximab, etanercept, adalimumab

Question 5

Juvenile idiopathic arthritis (JIA)- prognosis

Answer 5

50% go into adulthood
Early detection
Complication- slowed growth, short stature, leg length, blindness from uveitis

Question 6

Oligoarticular JIA- Pauciarticular JRA- epidemiology

Answer 6

1-7y
Peak 2-3
F>M

Question 7

Oligoarticular JIA- Pauciarticular JRA- S/S & PE

Answer 7

Asymmetric joint involvement 
<4 joints
Prominent morning stiffness 
Knees!!
Some fingers, wrists, elbows, ankles, toes

Question 8

Oligoarticular JIA- Pauciarticular JRA- labs & imaging

Answer 8

ANA- pos
ESR/CRP- mild inc
Slit-lamp exams- risk of uveitis- done until 18yo —> blindness

Question 9

Polyarticular JIA- S/S & PE

Answer 9

> 5 joints

Question 10

Polyarticular JIA- labs & imaging

Answer 10

Polyarticular JIA
ESR - inc
CRP - nl or inc
Anemia - mild
RF = pos - usually teenage girls 
     - symmetric, small joints hands and feet
     - like adult RA
     - aggressive and erosive disease
     - extraarticular - rheumatoid nodules, felty syndrome,  vasculitis, lung dx 
RF = neg - younger childern 
      - larger joints - knee, ankles, wrists
      - NO EXTRAARTICULAR features

Question 11

Systemic onset JIA- Still’s disease- epidemiology

Answer 11

Any age

B=G

Question 12

Systemic onset JIA- Still’s disease- S/S & PE

Answer 12

Daily quotidian fever- spikes and reduces —> Rabbit Ear Fever
Salmon-colored evanescent macular rash- w fever- trunk, extremities
Hepatomegaly, splenomegaly, lymphadenopathy, serositis
Look sikc
Pericarditis or macrophage activation syndrome- fecal complications

Question 13

Systemic onset JIA- Still’s disease- labs & imaging

Answer 13

Leukcytosis
ESR- inc
Ferritin- inc

Question 14

Systemic onset JIA- Still’s disease- treatment

Answer 14

Steroid- initial for symptom control

Question 15

Systemic onset JIA- Still’s disease- prognosis

Answer 15

Highest mortality

Question 16

Psoriatic arthritis- S/S & PE

Answer 16

>1 joint- small, medium joints 
DIP synovitis 
Dactylitis 
Nail pitting 
Psoriatic rash 
Acute anterior uveitis

Question 17

Psoriatic arthritis- labs & imaging

Answer 17

ESR/CRP- inc
ANA- pos- risk for uveitis
Need regular slit lamp exams !

Question 18

Enthesitis- related JIA- epidemiology

Answer 18

Males 
8-12 
Spondylitis 
Reactive arthritis 
Arthritis associated w inflammatory bowel disease 
Anterior uveitis

Question 19

Enthesitis- related JIA- S/S & PE

Answer 19

Sacroiliac tenderness

Pos HLA- B27

Question 20

Enthesitis- related JIA- labs & imaging

Answer 20

ESR/CRP- inc