Rheumatology Flashcards
1
Q
Five key areas
A
- Trauma (accidental and NAI)
- Infection (septic arthritis, osteomyelitis, reactive arthritis, Reiter’s syndrome, rheumatic fever)
- Tumour (leukaemia, primary bone tumours, neuroblastoma)
- Inflammation (JIA, vasculitis - HSP and Kawasaki disease)
- Normal variants (benign night pains, flat feet, in-toeing, normal growth)
NB - Also remember mechanical, muscule disease and metabolic.
2
Q
Juvenile idiopathic arthritis (JIA)
A
- Disease of childhood onset characterised primarily by arthritis persisting for at least 6 weeks and currently having no known cause
- Chronic inflammatory arthropathy
- Commonest rheumatic disease in childhood
- Clinical diagnosis with no diagnostic tests
- Group of diseases - overlap with adult inflammatory arthropathies
3
Q
Arthritis in adults vs children
A
4
Q
Uveitis
A
- 30% oligoarthritis
- 10% other JIA
- 50% extended oligoarthritis
NB - Screening by paediatric ophthalmologist using slitlamp
5
Q
What is an enthesis?
A
- Insertion to bone of:
- Tendon
- Ligament
- Joint capsule
- Fascia
- Enthesis associated arthritis commonly presents in:
- Ankylosing spondylitis
- Reiter’s syndrome
- Conjunctivitis
- Urethritis
- Plantar fasciitis
- Arthritis
- IBD arthritis
6
Q
Seronegative vs seropositive
A
- Seronegative
- Asymmetrical
- Large lower limb joint (AS/ERA/Reiter’s/IBD)
- Large and small joint (psoriatic)
- Seropositive
- Symmetrical
- Large and small joint arthritis
- Wrists and MCPs
7
Q
ALL
A
- Joint pain (shoulders, elbows, knees) - tender with warm effusions
- Young children (most common age 2-5)
- Tiredness and pallor
- Low Hb and normocytic normochromic anaemia
- Raised ESR and CRP
- ANA present in 1 in 40
- Marrow trephine for diagnosis
8
Q
Benign night pains
A
- 6 years of age
- Pain after physical activity
- Wake after exercise screaming at night
- Mum massages legs
- Maybe a dose of calpol
- Better next day
9
Q
Primary bone tumour
A
- 14 years
- Deep boring pain in R hip at night
- Struggles to school, given up paper round etc
- Limp
- Daytime pain
- Weight loss and fever
- Treatment assumes micrometastases so for Osteosarcoma chemo + surgery and in Ewing’s sarcoma chemo + surgery + autologous SCT + radiotherapy
- Long term follow-up due to treatment toxicity
10
Q
Rheumatic fever
A
- Age 5-17 years
- Painful migratory polyarthritis
- Not much to find in joints
- Fever
- Rash
- Loud pansystolic murmur
11
Q
Septic arthritis
A
- Painful joint
- Hot, red and swollen (not always seen in deep joints like the hip)
- Pseudoparalysis
- Pyrexia >38.5oC
- Inability to weight bear
- Raised ESR (>40mm/h), CRP and WCC (>12x109/l)
- Commonly staphylococcus aureus, streptococcus pneumoniae and haemophilus influenza
- Management
- ABCDE and resuscitation
- Aspiration with microscopy and gram stain, culture and sensitivity
- Blood cultures
- High dose IV antibiotics
12
Q
Osteomyelitis
A
- Classic presentation is acutely unwell child, pyrexia, local erythema and tenderness
- Swollen joint can mean you miss the painful adjacent bone
- X-ray sgows Brodie’s abscess in metaphysis
- Most often subacure presentation (limp, night pain, point tenderness)
- Management
- Blood cultures
- Bone aspiration
- High dose IV antibiotics
- Splintage of the limb
- Changes on X-ray occur late so normal does not exclude
13
Q
Henoch Schonlein Purpura (HSP)
A
- Most common vasculitis in children
- 50% under 6 years, 90% under 10 years
- Rash on extensor surfaces
- Arthritis is same pattern of joints
- Blood and protein in the urine
- HTN - glomerulonephritis
- Abdominal pain
14
Q
Kawasaki Disease
A
- Early features
- Fever
- Arthritis
- CV issues
- Rash
- Cervical lyphadenopathy
- Thrombocytosis
- Non-purulent conjunctivitis
- Late signs
- Aneurysms
- Peeling skin
- Cardiac ischaemia
- MI
- Treat with IVIG
15
Q
NAI
A
17
Q
Benign leg pain vs malignant leg pain
A
19
Q
Salter-Harris Classification of Growth Plate Injuries
A
