Rheumatology Flashcards
What is the presentation of JIA?
Arthritis for at least 6 weeks
Morning stiffness or gelling
Irritability or refusal to walk in toddlers
School absence or limited ability to participate in physical activity
Rash /fever
Fatigue
Poor appetite/weight loss
Delayed puberty
Presentation depends on the type of JIA (Polyarthritis (more than five joints involved)- RF negative and don’t grow out of the arthritis then goes into rheumatoid arthritis
Enthesitis Related arthritis-tendons involved
Psoriatic arthritis- have systemic symptoms like fever and rash)
Swelling:periarticular soft tissue edema/intraarticular effusion/hypertrophy of synovial membrane
Tenosynovitis(swollen tendons)
pain
Joint held in position of maximum comfort
range of motion limited at extremes.
What is the presentation of systemic JIA?
Unwell Arthritis Intermittent fever>2 weeks Salmon pink erythematous rash Generalized lymphadenopathy Serositis Hepatomegaly/splenomegaly High inflammatory markers
What is the difference in presentations of inflammatory markers in septic arthritis and JIA?
Differentiate as JIA has raised ESR not CRP, septic arthritis both are raised
What is the management of JIA?
Intra-articular steroids
If IAS dont work then use DMARDs, most used is methotrexate
Then use biologic agents if DMARDs dont work
What is the presentation of uveitis?
Rarely symptomatic
Red eyes, headache, reduced vision.
Complications are cataracts, glaucoma and blindness
What is the management of uveitis?
The same drugs that work for JIA work for uveitis
Initially topical steroids to reduce inflammation
More severe need systemic steroids
Poor response to steroids
DMARD and biologics
What are the complications of JIA?
Poor growth Localised growth disturbances (leg length discrepancies) Micrognathia (TMJ involvement) Contractures (if untreated) Ocular complications Osteopenia
What is septic arthritis?
Acute onset fever Joint pain and swelling Ill appearance Irritable if less than a year old Tachycardia, hypertensive Joint effusion Warm and hot joint Pain on movement Raised CRP and ESR Raised white cell count (neutrophils) and platelets Blood cultures will be negative Ultrasound to identify effusion IV antibiotics Can aspirate joint so easier to move and send away culture
What is a slipped upper femoral epiphysis?
Displacement of the capital femoral epiphysis from femoral neck More common in adolescence Associated with obesity Pain and altered gait Well child with no fever Worse with activity A radiograph will show “ice cream slipping of the cone” Refer to ortho
What is transient synovitis?
Pain and limited movement of the hip Usually from 3 to 8 years old Symptoms for less than one week Low grade or absent fever Well looking children Bilateral effusion in hip joint on US Resolves gradually with conservative treatment (analgesia) Followed up by GP
What is Perthes?
Idiopathic avascular necrosis of hip
Presents as insidious hip pain and limp
Pain not relieved by rest or medication, pain is constant
Presents in 3-12 year old
Usually unilateral but can be bilateral
On x-ray can see crumbled head of femur due to lack of blood supply
Manage by minimal weight bearing, refer to ortho, if joint is crumbled then use splint and if been on for long time need to do osteotomy
