Rheumatology Flashcards
Differential dx of monoarthritis (list 8)
Trauma
Infection
- Acute: septic arthritis, osteomyelitis
- Chronic: remember TB and Lyme!
Inflammatory: transient synovitis (short duration), JIA
Tumor: localized bone tumor
Hemarthrosis: consider bleeding disorder (vWD, hemophilia)
Mechanical/orthopedic: overuse (ex. Osgood-Schlatter), AVN, SCFE, Chondromalacia patellae (patellar femoral syndrome)
Pain syndrome: conversion, CRPS
Which organisms cause septic arthritis?
staphylococcus aureus Streptococcus pneumoniae Haemophilus influenza GBS E.coli Nisseria Gonorrhea Kingella Kingae
Describe the synovial fluid seen in septic arthritis
Synovial fluid WBC count > 50,000 (mostly neutrophils)
Kocher criteria?
fever > 38.5
ESR > 40 mm/hr
WBC > 12,000
refusal to weight bear
Basic labs required for febrile child with joint pain
CBC and differential, CRP, ESR, blood culture
Stages of Lyme disease, and their characteristics
o Early localized Lyme (< 30 days): erythema migrans + may have systemic symptoms, including arthralgia. Clinical diagnosis
o Early disseminated Lyme (skin – multiple EM, neuro – facial nerve palsy, meningitis, carditis – AV block, joints – migratory arthralgias).
o Late disseminated Lyme (4-6 weeks later): chronic intermittent arthritis, - usually monoarthritis of the knee; peripheral neuropathy, encephalomyelitis
List 6 clinical criteria of SLE
- Acute cutaneous lupus (lupus malar rash; bullous lupus; TEN variant of SLE; photosensitive lupus rash or subacute cutaneous lupus)
- Chronic cutaneous lupus (discoid lesions local and generalized)
- Oral or nasal ulcers
- Non-scarring alopecia
- Arthritis
- Serositis (pleurisy or pulmonary effusion or pericardial pain or pericardial effusion or rub or pericarditis)
- Renal (urine protein to Cr 500mg/24 hours or red blood cell casts)
- Neurologic (seizures, psychosis, peripheral or cranial neuropathy, acute confusional state)
- Hemolytic Anemia
- Leukopenia or lymphopenia
- Thrombocytopenia
List 4 immunologic criteria of SLE
- ANA
- Anti-DNA (specific)
- Anti-Sm
- Antiphospholipid antibody (lupus anticoagulant, false positive RPR, antiocardiolipid)
- Low complement (C3, C4)
- Direct Coombs test
Xray findings seen in JIA
soft tissue swelling and periarticular osteopenia; later narrowing of joint spaces, bone cysts, erosions, subluxations, ankylosis
Side effects of NSAIDS (list 5)
gastritis, headaches, dizziness, fatigue, hepatitis, nephrotoxicity (proteinuria or renal papillary necrosis), friability of skin, Reye syndrome
Cardiac complications of JIA
pericarditis, myocarditis (in systemic onset JIA)
Anterior uveitis most commonly occurs in which subtype of JIA?
oligoarticular JIA, ANA+
Diagnostic criteria of HLH/MAS
Initial diagnostic criteria:
- Fever
- Splenomegaly
- Cytopenias
- Hypertriglyceridemia and/or hypofibrinogenemia
- Hemophagocytosis in bone marrow or spleen or lymph nodes (no evidence malignancy)
New diagnostic criteria:
- Low or absent NK cell activity
- Increased Ferritin greater/equal 500 mg/L (>10,000 is sensitive and specific)
- Elevated soluble CD25
Diagnostic criteria for Kawasaki disease
Fever > 5 days and at least 4/5 of: - conjunctivitis - rash - adenopathy - extremity changes - oromucosal changes
List 5 items in the DDx of Kawasaki disease
- Viral infections: measles, echovirus, adenovirus
- Toxin mediated illnesses: Toxic shock syndrome (strep, staph), scarlet fever (group A strep)
- Drug reactions: Steven Johnson syndrome, serum sickness
- Systemic-onset JIA
Supplemental lab criteria for incomplete KD
If fever> 5 days, and 2-3 clinical criteria, ESR > 40, CRP > 3:
- Albumin < 3 g/dl
- Anemia for age
- Elevated ALT
- Platelets > 450,000 per mm3
- WBC > 15, 000
- Urine > 10 WBC/hpf
Cardiac complications of Kawasaki
- Coronary artery aneurysms (independent RF = male gender, delay of treatment > 10 days and IVIG retreatment)
- KD shock syndrome
- Myocarditis (prolonged PR, nonspecific ST and T wave changes)
- Reduced LV function and contractility
- CHF, valvulitis
- pericardial effusion or tamponade
- MI, coronary artery thrombosis, sudden death
- Vascular obstruction (thrombolysis then heparin)
Clinical features of JDM (Juvenile dermatomyositis)
• Phase 1: Prodromal phase: nonspecific aches and pains, low grade fever, edema hands/feet/eyelids, diffuse non-specific rash
• Phase 2: progression muscle weakness and rash (violaceous heliotrope rash, Gottron papules over extensor tendons, periungual erythema)
o Proximal muscle weakness
• Phase 3: persistent active disease and cumulative tissue damage
• Phase 4: indolent phase with contracture, muscle wasting, lipodystrophy, pigmentary changes and calcinosis
List systemic complications of polyarteritis nodosa
Cardiac: pericarditis, cardiomegaly
CNS: seizures, hemiparesis
GI: gut vasculitis
Pulmonary: diffuse infiltrates, pulmonary hemorrhage, hemothorax
Renal: proteinuria, urine sediment, HTN
Arthritis, livedo reticularis, urticarial, petechial rashes
List 5 complications of JDM (juvenile dermatomyositis)
- skin calcinosis
- proximal muscle weakness
- resp insufficiency (diaphragm weakness)
- contractures
- heliotrope rash
- Gottron papules
- GI bleed, perforation
