Rheumatology Flashcards
Juvenile idiopathic arthritis clinical symptoms
- Morning stiffness, joint redness, swelling, pain, rash
- Onset before 16 years of age
- Must be present for at least 6 weeks in at least one joint
- GIRLS are much more commonly affected than boys
Polyarticular JIA clinical signs
- 5 or more joints in the first 6 months of disease
- Small to medium joints and symmetrical
- Rarely have systemic symptoms
- Can be RF positive or RF negative
Oligoarticular JIA clinical signs
- 4 or fewer joints affected in the first 6 months of disease
- Medium to large joints, asymmetrical
- ANA positive, RF often negative (but if positive means worse disease)
- Common in young females (age 2-4)
- Boys with this disease are HLA-B27 positive
- MONITOR FOR CHRONIC UVEITIS (need ophtho consult, #1 treatable cause of blindness)
Systemic JIA
- Affects males and females, usually ages 1-5
- Systemic symptoms can occur before joint symptoms
- High fevers daily for at least 2 weeks
- Leukocytosis, elevated FERRITIN
- Rash (salmon colored macules that come and go)
- HSM, lymphadenopathy, pleuritis, pericarditis, serositis
- Uveitis is rare in systemic JIA
- RF and ANA often negative
Psoriatic arthritis
- Rash, arthritis, nail pitting, dactlitis
- More common in girls
- HLA-B27 positive
3 main differences between JIA and leukemia
- Timing of symptoms: JIA pain in morning, leukemia pain awakens the kid at night and typically doesn’t involve a joint
- Progression of symptoms: JIA are periodic and waxing/waning, leukemia is persistent and worsening
- Heme abnormalities: more severe in leukemia
JIA long term consequences
Leg length discrepancy, joint contractures, joint destruction, blindness from chronic uveitis, active disease in adulthood
JIA treatment
- PT/OT
- NSAIDs (indomethacin, ibuprofen, naproxen)
- Steroids and immunosuppressive meds
- Methotrexate (gold standard) - Can use anti-IL-1 (anakinra) for systemic onset
Teenager with night pain and morning stiffness relieved by exercise, pain of large joints (knee), low grade fever/weight loss
Ankylosing spondylitis
- HLA B27 antigen positive over 90% of the time
- ANA and RF negative
- Mainly affects sacroiliac joints
Ankylosing spondylitis imaging finding and associations
- Bamboo spine on xray
- Affects males
- Can involve the eye (irits and uveitis –> acute anterior uveitis)
- Associated with inflammatory bowel disease and aortitis (check for murmur)
School aged kid with rash on the face, scaly skin on extensor surfaces of the extremities and interphalangeal joints and large proximal muscle weakness
Juvenile dermatomyositis
- Can also have periungual red bumps (nail fold telangectasias)
- Heliotrope, violaceous, or butterfly malar rash
- Rash can be very itchy
- Gottron’s papules are the rash on the hands
- Muscle sx: difficulty getting dressed, clumsy, trouble climbing steps
- More common in females
- Often have elevated CK
Most common systemic vasculitis in kids involving the skin, GI tract, joints, and kidneys
HSP (IgA vasculitis)
- Slightly more common in boys
- Often has preceeding bacterial or viral infection
SLE vs JDM rash differences
- SLE rash on hands is between the joints, JDM is on the joints
- Facial rash is pretty similar but JDM may involve a bit more on the eyelids
School aged kid with palpable purpura on lower extremities/buttocks with colicky abdominal pain and heme positive stools
HSP
- Abd pain often from intussusception
- Renal involvement: hematuria, proteinuria, HTN
- Arthritis/arthralgias also common
HSP lab findings
- Elevated creatinine/BUN
- UA with protein and blood
- NORMAL platelets and PT/PTT
