Rheumatology Flashcards
What are red flag symptoms of joint pain in a child?
- Fever
- Malaise/lethargy
- Morning joint stiffness or pain
- Night pain refractory to simple analgesia and symptomatic during the daytime
What are red flig sign’s of joint pain in children?
- Joint swelling
- Bony tenderness to palpation
- Muscle weakness
- Fall in height or weight growth curve
What are benign symptoms of joint pain?
- Worse with activity and better with rest
- Worse at the end of the day
- If night pain relieved with simple analgesia
What are signs indicate joint pain is benign?
- No joint swelling
- No bony tenderness
- Normal strength
- Normal height and weight growth
If a child presented with joint pain, what would your differential diagnosis be?
- JIA
- Septic arthritis/osteomyelitis
- Growing pains
- Joint trauma
- Irritable hip
- HSP
- Haemarthrosis
- Rheumatic fever
- Serum sickness
- Reactive arthritis
- Hip problems - DDH, perthes, SUFE
If a child had joint pain, what bloods could you do to help narrow the diagnosis?
- FBC - wbc and neutrophil count
- CRP/ESR
- Blood film
- Blood cultures
In children aged 1-3, what can cause an acute painful limp?
- Infection - septic arthritis, osteomyelitis or hip
- Transient synovitis
- Trauma
- Malignancy - leukaemia, neuroblastoma
In children aged 1-3, what can cause a more chronic or intermittent limp?
- DDH
- Talipes
- Neuromuscular problems - CP
- JIA
In children aged 3-10 years, what problems can cause an chronic or intermittent limps?
- Perthes
- Neuromuscular disorders - DMD
- JIA
In children aged 3-10 years, what problems can cause an acute painful limp?
- Transient synovitis
- Septic arthritis/osteomyelitis
- Trauma/Overuse
- Perthes disease
- JIA
- Malignancy - leukaemia
- CRPS
In children aged 11-16, what can cause a chronic or intermittent limp?
- SUFE
- JIA
- Tarsal Coalition
In children aged 11-16, what can cause acute painful limps?
- Trauma/overuse
- SUFE
- Avascular necrosis of femoral head
- Reactive arthritis
- JIA
- Septic arthritis/osteomyelitis
- Osteochondritis dessicans
- Malignancy
- CRPS
What are growing pains?
Episodes of generalised pain in the lower limbs which are common in preschool and school-aged children.
Pain often wakens child from sleep and massaging/comforting helps
What features need to be present for the diagnosis of growing pains to be met?
Rules of Growing Pains:
- Age range 3-12 years
- Pain symmetrical in both limbs and not limited to joints
- Pains never present at start of the day
- Physical activities not limited/no limp
- Normal pGALS
What part of the bone does osteomyelitis affect?
Metaphysis
What are the most common sites to be affected by osteomyelitis?
- Distal femur
- Proximal tibia
What are the modes of spread of osteomyelitis?
- Haematogenous
- Direct spread from infected wound
What are the most common organisms which cause osteomyelitis?
- Staph. Aureus
- Streptococcus
- H. influenzae
How does osteomyelitis present in children?
- Painful, immobile limb - may be first thing in infant
- Fever
- Swelling over site + tenderness
What is juvenile idiopathic arthritis?
Defined as persistent joint swelling >6 weeks duration presenting before 16 years of age in the absence of infection or any other defined cause
What are the different types of JIA?
- Oligoarticular - Pauciarticular JIA
- Oligoarticular - Extended JIA
- Polyarthritis - Rh positive/negative
- Systemic onset arthritis
- Psoriatic Arthritis
- Enthesitis related arthritis
- Undifferentiated
What is the articular pattern of oligoarticular persistent JIA?
1-4 joints
Knee, ankle and wrist most common
What is the articular pattern of oligoarticular entended JIA?
>/= 5 joints after first 6 months
Asymmetrical distribution of large and small joints
What is the articular pattern of RF negative Polyarthritic JIA?
- Symmetrical large and small joint arthritis
- Marked finger involvement
- Cervical joints and TMJ may be involved
