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Paediatrics > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are red flag symptoms of joint pain in a child?

A
  • Fever
  • Malaise/lethargy
  • Morning joint stiffness or pain
  • Night pain refractory to simple analgesia and symptomatic during the daytime
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2
Q

What are red flig sign’s of joint pain in children?

A
  • Joint swelling
  • Bony tenderness to palpation
  • Muscle weakness
  • Fall in height or weight growth curve
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3
Q

What are benign symptoms of joint pain?

A
  • Worse with activity and better with rest
  • Worse at the end of the day
  • If night pain relieved with simple analgesia
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4
Q

What are signs indicate joint pain is benign?

A
  • No joint swelling
  • No bony tenderness
  • Normal strength
  • Normal height and weight growth
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5
Q

If a child presented with joint pain, what would your differential diagnosis be?

A
  • JIA
  • Septic arthritis/osteomyelitis
  • Growing pains
  • Joint trauma
  • Irritable hip
  • HSP
  • Haemarthrosis
  • Rheumatic fever
  • Serum sickness
  • Reactive arthritis
  • Hip problems - DDH, perthes, SUFE
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6
Q

If a child had joint pain, what bloods could you do to help narrow the diagnosis?

A
  • FBC - wbc and neutrophil count
  • CRP/ESR
  • Blood film
  • Blood cultures
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7
Q

In children aged 1-3, what can cause an acute painful limp?

A
  • Infection - septic arthritis, osteomyelitis or hip
  • Transient synovitis
  • Trauma
  • Malignancy - leukaemia, neuroblastoma
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8
Q

In children aged 1-3, what can cause a more chronic or intermittent limp?

A
  • DDH
  • Talipes
  • Neuromuscular problems - CP
  • JIA
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9
Q

In children aged 3-10 years, what problems can cause an chronic or intermittent limps?

A
  • Perthes
  • Neuromuscular disorders - DMD
  • JIA
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10
Q

In children aged 3-10 years, what problems can cause an acute painful limp?

A
  • Transient synovitis
  • Septic arthritis/osteomyelitis
  • Trauma/Overuse
  • Perthes disease
  • JIA
  • Malignancy - leukaemia
  • CRPS
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11
Q

In children aged 11-16, what can cause a chronic or intermittent limp?

A
  • SUFE
  • JIA
  • Tarsal Coalition
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12
Q

In children aged 11-16, what can cause acute painful limps?

A
  • Trauma/overuse
  • SUFE
  • Avascular necrosis of femoral head
  • Reactive arthritis
  • JIA
  • Septic arthritis/osteomyelitis
  • Osteochondritis dessicans
  • Malignancy
  • CRPS
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13
Q

What are growing pains?

A

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

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14
Q

What features need to be present for the diagnosis of growing pains to be met?

A

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
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15
Q

What part of the bone does osteomyelitis affect?

A

Metaphysis

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16
Q

What are the most common sites to be affected by osteomyelitis?

A
  • Distal femur
  • Proximal tibia
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17
Q

What are the modes of spread of osteomyelitis?

A
  • Haematogenous
  • Direct spread from infected wound
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18
Q

What are the most common organisms which cause osteomyelitis?

A
  • Staph. Aureus
  • Streptococcus
  • H. influenzae
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19
Q

How does osteomyelitis present in children?

A
  • Painful, immobile limb - may be first thing in infant
  • Fever
  • Swelling over site + tenderness
20
Q

What is juvenile idiopathic arthritis?

A

Defined as persistent joint swelling >6 weeks duration presenting before 16 years of age in the absence of infection or any other defined cause

21
Q

What are the different types of JIA?

A
  • Oligoarticular - Pauciarticular JIA
  • Oligoarticular - Extended JIA
  • Polyarthritis - Rh positive/negative
  • Systemic onset arthritis
  • Psoriatic Arthritis
  • Enthesitis related arthritis
  • Undifferentiated
22
Q

What is the articular pattern of oligoarticular persistent JIA?

A

1-4 joints

Knee, ankle and wrist most common

23
Q

What is the articular pattern of oligoarticular entended JIA?

A

>/= 5 joints after first 6 months

Asymmetrical distribution of large and small joints

24
Q

What is the articular pattern of RF negative Polyarthritic JIA?

A
  • Symmetrical large and small joint arthritis
  • Marked finger involvement
  • Cervical joints and TMJ may be involved
25
Q

What is the articular pattern of RF postivie Polyarthritic JIA?

A
  • Symmetrical large and small joint arthritis
  • Marked finger involvement
26
Q

What is the articular pattern of systemic onset JIA?

A

INITIALLY NO ARTHRITIS

Oligo/polyarthritis

Aches and pains in joints and muscles

27
Q

What are the features of psoriatic arthritis?

A
  • Asymmetrical distribution large and small joints
  • Dacytlitis
  • Psoriasis
  • Nail pitting
  • Onycolysis
  • Chronic anterior uveitis
28
Q

What are the features of enthesitis related JIA?

A
  • Lower limb - large joints initially
  • Mild lumbar/SI involvement
  • Enthesitis
29
Q

What are the extra articular features of RF negative polyarticular JIA?

A
  • Low-grade fever
  • Chronic anterior uveitis
30
Q

What are the extra articular features of RF positive Polyarthritic JIA?

A

Rheumatoid nodules (10 %)

Similar to adult rheumatoid arthritis

31
Q

Which has a poorer prognosis; RF positive or RF negative polyarticular JIA?

A

RF positive JIA

32
Q

What are the extra-articular features of systemic onset JIA?

A
  • Acute illness
  • Malaise
  • High daily fever
  • Salmon pink macular rash
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Serositis
33
Q

What are extra-articular features of persistent and extended oligoarticular JIA?

A

Chronic anterior uveitis (20%)

34
Q

What are complications of JIA?

A
  • Chornic anterior uveitis -> blindness
  • Flexion contractures of the joints
  • Growth failure
  • Osteoporosis
  • Anaemia of chronic disease
  • Delayed puberty
  • Amyloidosis (very rare)
35
Q

What is chronic anterior uveitis?

A

Inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea

Signs include:

  • Burning/Redness
  • Blurred vision
  • Photophobia or sensitivity to light
  • Irregular pupil
  • Dilated ciliary vessels
36
Q

Why do flexion contractures occur in the joints of those with JIA?

A

Joint is held in the most comfortable position , thereby minimising pressure within the joint

37
Q

What limits the spread of metaphyseal infection in children which isn’t present in infants?

A

Growth plates

38
Q

If you suspected JIA, how would you confirm your diagnosis?

A

Exclude differential diagnosis

  • Clinical Examination - Most important - examination of ALL joints
    • Movement restriction is often most important sign
  • Consider:
    • ANA
    • HLA-B27
    • Inflammatory markers (CRP, ESR, WBC, platelets)
    • RF
    • X-ray, MRI
39
Q

Which sex is JIA more common in?

A

Female - 3:1

40
Q

How would you manage a child with JIA?

A
  • Regular opthalmalogical review
  • Drug treatment
    • Short Term - NSAID, Intraarticular injections, Systemic steroids in polyarticular JIA
    • Long Term - DMARD (Methotrexate, Biologics)
  • Physiotherapy
  • OT
  • Psychotherapy
41
Q

What is transient synovitis?

A

Irritable hip

Most common cause of acute hip pain in children

Often follows/accompanied by viral infection

42
Q

How does transient synovitis present?

A
  • Sudden onset hip pain with limp
  • No pain at rest
  • Decreased movement - particularly internal rotation
  • Referred pain - knee
43
Q

If a child presents with symptoms of transient synovitis, what must yoiu rule out before making the diagnosis?

A

Septic arthritis - joint aspiration and BCs

44
Q

What is reactive arthritis?

A

Transient joint swelling (usually < 6 weeks) often of ankles or knees, which usually follows extra-articular infection

45
Q

What are the common causes of reactive arthritis in children?

A

Enteric organisms - salmonella, campylobacter, shigella, yersinia

Paediatrics (27 decks)

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