rheumatology Flashcards
approach a child with limp or painful joint
elevated CRP and ESR,
ultrasound
management septic arthritis
intravenous broad spectrum antibiotics
joint aspiration***
referral to orthopaedics
transient synovitis
not unwell at all pain and limited movement in hip bilateral effusion common resolves gradually with conservative therapy
juvenile idiopathic arthritis
most common chronic rheumatologic disease in children
not all swollen joints are JIA
diagnosis of exclusion
-genetics susceptibility immune response pro-inflammatory markers presence of antibodies ongoing research
-arthritis at least 6 weeks morning stiffness refusal to walk in toddlers rash/fever fatigue poor appetite delayed puberty
septic arthritis red big swollen hot joint
JIA, big effusion, warm not very hot
psoriasis
pitting of the nails
systemic JIA
unwell
intermittent fever> 2 weeks
salmon pink erythematous rash
generalized lymphadepathy
hepato splenomegaly
4 year old with right knee sowollen and high fever rash
high inflammatory markers, salmon pink rash-disappears with increase temperature
goals of treatment
DMARDS
Biologic treatment
Occupational therapists
education- talk to teachers, and facilitate
intraarticular steroids
highly efficacious
remission
DMARDS
methotrexate
poor response to IAS^
should be used early
biologic agents
failure to respond DMARD anti TNF agents commonly used
good safety profile
uveitis
drugs for arthritis also work for this
complications of JIA
poor growth osteopenia localised growth disturbances micrognathia contractures ocular complications
