RHEUMATOLOGY Flashcards
A 7-year-old with morning stiffness, knee and
ankle swelling for 2 months, ESR is normal,
antinuclear antibody (ANA) 1:160
Oligoarticular juvenile idiopathic arthritis (JIA)
A 2-year-old female with recently diagnosed oligo JIA and positive ANA requires frequent screening for this comorbidity
Chronic anterior uveitis
Fatigue, weight loss, arthritis in multiple joints for > 6 weeks, positive RF, anti-cyclic citrullinated peptide antibodies present and ANA is negative
Polyarticular JIA
Fatigue, weight loss, no fever, arthritis in multiple joints, negative RF, ANA is positive
Polyarticular JIA with an increased risk of
uveitis
A 5-year-old girl recently diagnosed with JIA, her
ANA is positive; how frequently does she need
screening for uveitis?
Every 3–4 months (JIA, < 7 years and positive
ANA is the highest risk of uveitis)
A 9-year-old girl recently diagnosed with JIA, her
ANA is positive, how frequently does she need
screening for uveitis?
Every 6 months (JIA, > 7 years and positive
ANA)
An 8-year-old with knee pain for 6 weeks, noted to have pain, swelling, decreased range of motion, difficulty bearing weight, synovial fluid shows decreased viscosity and WBC 15,000
Inflammatory arthritis
Fever, salmon-colored rash with fever and hot
showers, arthritis in major joints, hepatosplenomegaly, leukocytosis, thrombocytosis, anemia of chronic disease, elevated ESR, negative RF, and negative ANA
Systemic JIA
Side effects include immunosuppression, adrenal suppression, weight gain, cushingoid facies, diabetes and acne
Corticosteroids
This test is very sensitive but not specific for SLE
Antinuclear antibody (ANA)
Child with systemic JIA presents with elevated
liver enzymes, prolonged PTT, positive D-dimer,
thrombocytopenia, hyperferritinemia, and low ESR
Macrophage activation syndrome
An African-American girl with pericarditis,
pleurisy, recurrent oral ulcers, hemolytic anemia, and RBC casts in urine
SLE
Malar rash, arthritis, proteinuria, leucopenia,
thrombocytopenia, positive ANA, and anti-dsDNA
Systemic lupus erythematosus (SLE)
Autoantibodies associated with arterial/venous
thrombosis or recurrent miscarriage (in patients
with or without SLE)
Antiphospholipid antibodies
The most severe type of lupus nephritis resulting in hematuria, proteinuria, elevated blood pressure and can lead to end-stage renal disease
Diffuse lupus nephritis (membranoproliferative,
class IV)
Neonate born with heart block, annular erythematous plaques, anemia, thrombocytopenia, and elevated liver enzymes, positive SSA (Ro) and SSB (La) antibodies
Neonatal lupus
Recurrent parotitis, xerophthalmia, conjunctivitis, xerostomia, positive ANA, RF, and anti-Ro
Sjögren syndrome
A 7-year-old female, with proximal muscle
weakness in both sides, arthralgia, heliotrope rash, elevated creatine phosphokinase (CPK) and LDH
Juvenile dermatomyositis
A 6-year-old female with difficulty climbing stairs and voice change, Gottron papules and abnormal nailfolds, and telangiectasias
Juvenile dermatomyositis
A 15-year-old had diarrhea positive for Yersinia
2 weeks ago, now is having conjunctivitis,
urethritis, arthritis of the hip and knee
Reactive arthritis
Adolescent with inflammatory bowel disease
(IBD) has arthritis
Arthritis-related to IBD
An 8-year-old, pain in the sacroiliac joint,
tenderness, stiffness and joint pain in the morning that improves with activity, and positive HLA-B27
Enthesitis-related arthropathies
Child with nail pitting, psoriasis, arthritis, positive ANA
Juvenile psoriatic arthritis
Adolescent with recurrent oral and genital ulcers, positive pathergy test
Behçet disease
Adolescent girl with chronic left foot pain,
minimal touch aggravates the pain, foot is swollen, warm to touch, and mottled skin
Complex regional pain syndrome or reflex
sympathetic dystrophy (RSD)
Adolescent, 1 year with fatigue, multiple areas of pain, tenderness, no signs of inflammation, and labs are normal
Fibromyalgia
A 7-year-old boy with pain in both legs, worse in
the evening, sometimes awakens him from sleep, no fever, no limping, joints are normal on exam, pain responds to ibuprofen and heat massage
Growing pain
A 5-year-old boy with acute onset palpable
purpura on lower extremities, joint swelling and
abdominal pain, labs reveal normal CBC, PT and
PTT, positive proteinuria
Henoch-Schönlein purpura (HSP)
An 18-month-old with fever for 6 days, rash,
conjunctivitis, strawberry tongue, and erythema of the palms and soles
Kawasaki disease
The primary treatment for Kawasaki disease,
ideally given between day 5 and 10 of illness
IVIG, aspirin
A 15-year-old female with fatigue, weight loss,
recurrent sinusitis, and joint pain. Labs reveal
hematuria, proteinuria, and positive cANCA
Granulomatous polyangiitis (GPA, formerly
Wegener granulomatosis)
Pain, numbness, and discoloration of fingers (white then blue then red) that is triggered by cold weather
Raynaud’s disease
A 14-year-old female with severe Raynaud disease with ulceration on her fingertip, tightening of her skin, sclerodactyly, positive ANA, positive anti-Scl-70
Systemic sclerosis
A 12-year-old female with a linear hyperpigmented lesion on her leg that appears white and sclerotic in the center and has an erythematous border
Localized scleroderma
A chest radiograph with pulmonary infiltrates and hilar adenopathy, biopsy with non-caseating granulomas, elevated ACE
Sarcoidosis
Recurrent knee arthritis in an otherwise well child with a prior history of camping in the woods
Lyme arthritis
Newborn infant presents a few hours after birth
with hypotonia, facial muscle weakness, ptosis,
weak cry, respiratory distress, the mother has a
history of muscle weakness
Neonatal myasthenia gravis
Adolescent with muscle weakness, worsens with
repetitive movement and at the end of the day,
difficulty breathing, abnormal ocular movement
Juvenile myasthenia gravis
A 3-year-old child from the Middle East, recurrent fever and abdominal pain, during the episode the ESR and CRP are elevated, WBC 25,000
Familial Mediterranean fever
Child with fever for 3–5 days every month
associated with mouth ulcers, throat pain, cervical lymphadenitis. The patient is well in- between episodes
PFAPA (periodic fever, aphthous stomatitis,
pharyngitis, and cervical adenitis)
