Rheumatology Flashcards
Classification of JIA
How many joints in oligo?
How many in polyarticular?
Classification of Juvenile
Idiopathic Arthritis JIA (1998)
1. Oligoarticular: < 4 joint
- Persistent
- Extended
2. Polyarticular: ≥ 5 joints
- RF positive
- RF negative
3. Systemic: fever, rash
4. Enthesitis related arthritis
5. Psoriatic arthritis: Psoriasis and arthritis
6. Undifferentiated
What classifies as arthritis?
- Joint Swelling or Effusion
OR - ≥2 of the following:
- Limited ROM
- Tenderness or pain on motion
- Increased heat
(second criteria used more for joints that you cant see like hip joints)
Juvenile = started in childhood at what age?
* Idiopathic = Other causes of arthritis ruled out, such as infection, injury, etc.
* Arthritis = joint inflammation more than HOW MANY WEEKs, pain, tenderness, swelling, warmth, loss of movement, stiffness)
* NO DIAGNOSTIC TEST!!
Juvenile = started in childhood < 16 years age)
* Idiopathic = Other causes of arthritis ruled out, such as infection, injury, etc.
* Arthritis = joint inflammation more than 6 weeks pain, tenderness, swelling, warmth, loss of movement, stiffness)
* NO DIAGNOSTIC TEST!!
Enthesitis related arthritis more common in girls or boys?
Boys
Name two infections which can cause CHRONIC arthritis
TB and Lyme
JIA and sJIA more common in boys or girls?
girls
Which type of arthritis is linked to IBD?
enthesistis related
gonococcal arthritis typically affects what joint?
knee (usually very painful)
what virus can cause acute polyarthritis?
parvovirus
How many days does Kingella kingae need to grow on culture?
up to 7 days, normal joint aspirations, cultures only cultured for 5 days
What are Kochers criteria to differentiate septic arthritis from other causes of arthritis?
Septic Arthritis of the hip:
Kocher’s Criteria
* Refusal to weight bear
* Fever (oral temperature >38.5° Cor 101.5° F)
* 1WBC (>12,000/mm3)
* 1 Inflammatory Markers
(ESR (>40mm/hr) or
^CRP (>20mg/dL)
* 0/4: 0.2%
* 1/4:3%
* 2/4: 40%
* 3/4: 93%
* 4/ 4:99.6%
Minor criteria for ARF (4)
- Fever
- Arthralgia
- Increased ESR, CRP
- ECG changes:
Prolonged PR interval
JONES major criteria for ARF
How many major and minor criteria do you need to meet jones criteria?
2 major OR 1 major and 2 minor with evidence of recent strep infection
Epidemiology and clinical presentation of oligoarticular JIA
- Peak onset age 1-3 yo
- Girls > boys
- Large joints - knee most common, flexion contracture (also ankles, wrists, elbows)
- ANA positive in 80%
- RF negative (has to be negative)
Risk factors for asymptomatic uveitis associated with JIA
Girls
Young onset age
Oligoarticular JIA
ANA positivity
6 complications of JIA
A 4 year old girl presents with a left knee effusion for 1 month.
She limps in the morning but is otherwise well. While awaiting the results of your initial investigations which of the following would be most appropriate?
1. Treat with naproxen and reassess in 2-3 weeks.
2. Inject the knee with a long-acting corticosteroid
3. Aspirate synovial fluid from the knee for symptomatic relief
4. Treat with naproxen for I week followed by a short course of prednisone if there is no improvement
5. Refer to a rheumatologist before initiating any treatment.
Dont use steroids. Can mask bad things like malignancy and infection.
If you aspirate fluid it will just reaccumulate.
Treatment for oligoarticular JIA
Clinical presentation of RF- polyarticular JIA
Clinical presentation of RF+ polyarticular JIA
Usually more severe arthritis
Clinical presentation of Enthesistis related arthritis
Rheumatologic causes of MAS (3)
sJIA, kawasaki, SLE
Which antibodies are sensitive for diagnosis of lupus? Which antibodies are specific for lupus?
ANA–>sensitive
anti-DNA, anti-Sm–>specific
antiphospholipid antibodies, anti RNP, anti Ro, Anti-La also often positive
4 features of anti phospholipid antibody syndrome
thromboses, thrombocytopenia, recurrent abortion, hemolytic anemia
3 parts of anti phospholipid antibody syndrome diagnosis
prolonged PTT, anticardiolipin antibodies, lupus anticoagulant
