Rheumatology Flashcards
What are some of the extra-articular causes of a limp in a child?
Footwear
Trauma on soles of feet
Infection
Red flags of a child with a limp?
High fever
Weight loss
Night pain
Lethargy
New cardiac murmur
Lab results for septic arthritis?
Elevated CRP and ESR
Raised WBC and platelets
Blood cultures may help identify causative microorganism
Associations of SUFE?
Obesity
Adolescents
Worse with activity
What happens in SUFE?
Displacement of the capital femoral epiphysis from the femoral neck
->on x-ray, has ‘ice cream slipping off cone appearance’, useful to remember due to association w obesity
How does transient synovitis present?
Pain and limited movement in the hip
Normally not a fever, or low grade fever
Perthes disease?
Idiopathic avascular necrosis of the hi[
How does Perthes disease present?
Insidious hip pain and limp
Not relieved by rest or medication
-> more common in boys aged 3-12
Management of Perthes disease?
Minimal weight bearing
Contain head within acetabulum using splints
Occasional surgery
->involve paediatric orthopaedics
Symptoms of JIA?
Arthritis for at least 6wks
Morning stiffness
Refusal to walk in toddlers
School absence or limitations to participate in physical activity
Rash/fever
Fatigue
Poor appetite/weight loss
Delayed puberty
Oligoarthritis?
Four or less joints affected
Polyarthritis?
Five or more joints affected
Systemic onset JIA?
Presents with features of systemic inflammation
Upon clinical examination, swelling of joints is noticed
Sings of JIA?
Swelling
Tenosynovitis (swollen tendons)
Tenderness
Joint held in position of maximum comfort
Range of motion limited at extremities
Pharmacological treatment of JIA?
NSAIDs
SMARDs
Biologics
Intra-articular and oral steroids
Give an example of a DMARD.
Methotrexate
->requires blood monitoring
If there is a failure to respond to DMARDs, what are used?
Biologics, anti-TNF agents are commonly used
Which extraarticular issue is associated with JIA?
Uveitis
->if untreated can progress to chronic uveitis, cataracts, glaucoma and blindness
Treatment of uveitis?
Initially topical steroids to reduce inflammation.
May need more systemic steroids if severe
If poor response to steroids, DMARDs and biologics.
List some of the complications of JIA.
Poor growth
Osteopenia
Localised growth disturbances
Ocular complications
