Rheumatology Flashcards
Child w/ abdo pain + arthritis. Purpura on buttocks. Likely Dx? MOST common cause of long-term morbidity?
- Henoch Schonlein Purpura
2. HTN and renal Dx
What is Henoch Schonlein Purpura?
- vasculitis of small vessel
- typically 4-6 y.o.
- IgA deposition
- URTI 1-3 wk before CC
- Triad: Palpable Purpuric rash + Arthritis + Abdo Pain
- No coag
- U/A monthly till 6 mo. and F/U for HTN
- Rare complications: hematuria, HTN, V/D, intussusception, neuro (h/a, sz), pul hemm
- 1/3 cases recur
What is HSP Dx criteria?
Petechiae/purpura + min. 1 of: > arthritis/ arthralgia > abdo pain > renal > histopathology (IgA deposition)
T or F: amount of arthritis dictate long term prognosis in HSP.
False.
- Severity of nephritis key (HTN, CKD)
List 3 complication of arthritis:
- Flexion contracture
- Leg length discrepancy
- Growth retardation
- Osteoporosis
3 y.o. right knee swelling. Best initial tx?
- steroid
- MTX
- NSAID
NSAID
Mono arthritis x few weeks. Likely test result
- (+) RF
- (+) ANA
- (+) WBC
- (+) ESR
- decreased Hgb
(+) ESR
Note: RF only if poly; help with prognosis
Post reactive arthritis with painless contracture. 3 non-pharm tx:
- Stretching/ Physio
- Bracing
- Botox
- Surgical
Monoarthritis. Name 3 meds from different class for Tx:
- NSAID
- ibuprofen, naproxen - Dx Modifying AntiRheumatic Drug (DMARD)
- MTX (hep, pneumonitis, hepatitis, cytopenia) - Systemic Corticosteroids
- Cytotoxic agent= Cyclosporine
- Biologic
- Adalimumab, Infliximab - Immunosuppressant
- Mycophenolate Mofetil
- Cyclophosphamide
Which is best confirmatory test for juvenile dermatomyositis?
- EMG
- CK
- ANA
EMG or BX
Key feature= proximal muscle weak + rash (Gottron knuckle, Heliotrope)
Other feature: Nailfold capillary dilatation, myalgia
Rheumatic fever mnemonic?
JONES= prior strep + 2 major or 1 major and 2 minor
Joints= migratory polyrarthritis O = draw hear instead= carditis N= nodules, subcutaneous E= erythema marginatum S= sydenham chorea
Minor: fever, arthralgia, ESR, CRP
Migratory polyarthritis. Likely dx?
acute rheumatic fever
How do you treat acute rheumatic fever?
- bed rest and watch for carditis
- ambulate once signs of ARF subsided
- Abx: 10d pen to eradicate strep infection
- ASA x 2mo (or joint pain resolves) or steroids if carditis
Secondary prophylaxis:
- ARF carditis but no heart dx= 10 yr or until 21 y.o.
- ARF without carditis= 5 yr or until 21 (whichever longer)
Child with migratory arthritis, fever, normal echo. ASOT high. Tx:
- ASA until arthritis gone
- ASA PRN and 10d pen
- ASA until arthritis gone and 10 d pen
- ASA until arthritis resolve, 10d pen, IM monthly pen
ASA until arthritis resolves
Tx 10 d w/ pen
Then q monthly IM pen
What is Reiter syndrome? list 4 organisms that could be linked to this
Reiter Syn:
- Uveitis, Urethritis, Arthritis
- can’t see, can’t pee, can’t climb a tree
4 organisms: Chlamydia trachoma’s, Salmonella, Shigella, Ureaplasma
8 y.o. choreoathetotic movement. Handwriting worse. Emotionally labile. Throat Cx (-). Likely dx?
- Huntington’s chorea
- Sydenham’s chorea
- SLE
Sydenham’s chorea
List a ddx for chorea
chorea= brief + random + all over
Genetic: Huntington, Ataxia Telangiectasis
Structural: Stroke, Mass, MS
Parainfectious/AI: Sydenham, SLE
Infection: HIV, Toxo
Metabolic: Na, Ca, thyroid
What is sydenham chorea?
Neuro manifestation of rheumatic fever (due to Group A strep)
What is the most common acquired case of chorea?
Sydenham Chorea (from ARF)
What is Sydenham chorea classic ppt?
Chorea
+ Emotional Lability
+ Hypotonia
When does sydenham chorea usually resolve
6-9 month
if impairing f’n= VPA, carbmazepine
Rheumatic fever. What causes long-lasting problems
Carditis
- arthritis and chorea resolve without sequelae
- longterm= heart
Recurrent fever. Evanescent rash. Lymphadenopathy. MSK normal. Dx?
Systemic JIA
How do you define systemic JIA
arthritis w/ or preceded by fever min. 2 wk
(note quotidian= daily fever x 3 d)
\+ min 1 OF > evanescent red rash > node > HSM > serositis
