Rheumatology Flashcards
What are features of septic arthritis?
Acute onset of fever Joint pain and swelling Ill appearance Irritable Tachycardia Joint eddusion Periarticular warmth and tenderness Pain on movement Any age
What are investigations for septic arthritis?
Very high CRP and ESR Raised WCC High platelets Blood cultures taken but results are negative Ultrasound may show effusion
How is septic arthritis managed?
Referral to orthopaedics
Empirical broad spectrum IV antibiotics
Joint aspiration - help child move joint by reducing fluid and also microscopy and culture to determine causative organism
What are features of Slipped Upper Femoral Epiphysis?
Displacement of the capital femoral epiphysis from femoral neck Most common hip disorder in adolescence Associated with obesity Pain and altered gait Worse with activity
What is the main feature of SUFE Xray?
‘Ice cream slipping off cone’
How is SUFE managed?
Referral to orthopaedicss
What are features of transient synovitis?
Pain and limited movement in hips Relatively common Unclear aetiology 3-8 years age group Symptoms<1 week Fever absent or low grade Not unwell looking Bilateral effusion on ultrasound Resolve gradually with conservative therapy - analgesia
What are features of perthes?
Idiopathic avascular necrosis of hip joint Presents as insidious hip pain and limp Pain not relieved by rest or medication 3-12 years Males more common - 3.5:1 Undefined aetiology
How is perthes managed?
Minimal weight bearing
Contain head within acetabulum with use of splints
Occassional surgery
Refer to orthopaedics
What determines outcome of perthes
Age at onset - Younger better outcome
Depends on degree of involvement of femoral head
What are potential causes of JIA?
Genetic susceptibility Immune response Pro-inflammatory markers Presence antibodies Ongoing research
What are symptoms of JIA?
Arthritis for at least 6 weeks Morning stiffness or gelling Refusal to walk in toddlers School absence or limited ability to participate in physical activity Rash/fever Fatigue Poor appetite/weight loss Delayed puberty
What are different types of JIA?
Oligoarthritis Polyarthritis (Rheumatoid factor + or -) Enthesitis related arthritis - tendons Psoriatic arthritis - related to psoriasis Systemic onset JIA Undifferentiated arthritis
What are signs of JIA?
Swelling Tensosynovitis Pain Joint held in position of maximum comfort Range of motion limited at extremes
What are features of systemic JIA?
Unwell Arthritis Intermittent fever >2 weeks Salmon pink erythematous rash Generalised lymphadenopathy Serositis Hepatomegaly/splenomegaly High inflammatory markers - ESR and CRP
How is the specific type of arthritis diagnosed?
History
Physical examination and findings
Investigations
What investigations?
Labs - WCC, CRP, ESR,
Plain Xray
USS
MRI with contrast
What are goals of treatment for arthritis?
Pharmaological management consisting of NSAIDs, DMARDs, biologics, and intra-articular/oral steroids Nutrition Physio Return to school Occupational therapy
What is the DMARD of choice?
Methotrexate
What are features od DMARDs for JIA?
Used when steroids don’t work in oligo JIA
Used early for good outcome
What is the most common associated symptom of JIA?
Uveitis
What are features of uveitis in JIA?
Untreated leads to chronic Screening in all JIA patients <5 years Rarely symptomatic Red eyes, headache, reduced vision If not treated cataracts, glaucoma
How is uveitis treated?
Topical steroids to reduce inflammation
DMARDs and biologics if poor response to steroids
What are complications of JIA?
Poor growth Osteopenia Localised growth disturbances - leg length discrepancy Micrognathia Contractures Ocular complications
