wk 6- arthritis, connective tissue disease

Question 1

diagnosing criteria for juvenile rhematoid arthritis

Answer 1

criteria of 4 things:

1. Chronic synovia l infla mmation of unknown origin
2. Onset in children less than 16 yea rs of age
3. Objective evidence of arthritis in one or more joints for 6 consecutive weeks
4. Exclusion of other diseases

Question 2

3 types of JRA

Answer 2

1. Pauciarticular or monarticular JRA (~40%)
   * 4 or fewer joint affected Asymmetrical or symmetrical
   * Early or late onset discrete joints affected
2. Polyarticular JRA(~20%)
   * 5 or more joint involved
   * Seronegative (early onset) or seropositive (late onset)
3. Systemic JRA (Still’s disease) (~20%)
   * Often symmetrical onset usually <5 yrs onset with fever &precipitated by
   infection

Question 3

Is there a specific test for JRA

Answer 3

No

Question 4

Does JRA show up on imaging

Answer 4

late in disease

Question 5

what imaging is gold standard for JRA

Answer 5

MRI
early cartilage and soft tissue changes and synovitis

Question 6

what health profession helps with JRA

Answer 6

peads rehmatologist

Question 7

TREATMENT for JRA

Answer 7

1. Aspirin/NSAIDs
2. intravenous and intra articular corticosteroids
3. methotrexate
4. biologic if MTX doesnt work
   and physical therapy for muscle strength and joint ROM

can also use hydrotherapy

Question 8

prognosis of JRA

Answer 8

up to 60% of cases resolve prior to adulthood

Question 9

role of podiatrist for treatment of JRA

Answer 9

-manage ROM
-prevent joint alignment issues
-footwear advice/modification
-padding/strapping
-orthoses

Question 10

what impression do you take of accomodative othroses’

Answer 10

Foam impression box (SWB/WB/as it lies)- no STJ neurtral

capturing in a compensated foot

Question 11

what impression do you take of functional orthoses

Answer 11

suspension cast- holding foot in position that will influence the outcome of orthosis

Question 12

what joints is septic arthritis common in

Answer 12

large joints (hip, knee, elbow, shoulder)

Question 13

clinical features of septic arthritis in infant

Answer 13

fever, irritable, sepsis abnormal posture, joint pain, psudeoparalysis

Question 14

clinical features of septic arthritis in child

Answer 14

fever, severe pain, muscle spasms

Question 15

what is septic arthritis caused by

Answer 15

bacteria carried by bloodstream from infectious focus elsewhere that penetrates the joint

Question 16

what investigations could you use to diagnose septic arthritis

Answer 16

CRP/ESR elevated levels
radiography/US for effusion levels
joint aspiration

Question 17

what is the most common cause of limp with hip pain in kids under 10

Answer 17

transient synovitis of hip (inflammatory arthirtis of hip)

Question 18

clinical features of transient synovitis of hip

Answer 18

pain i hip, anteromedial thigh and knee, reduced range of motion, limp, unilateral pain, psuedo paralysis (kids dont want to move joint)

Question 19

difference in ROM, fever, ESR and synovial fluid in transient synovitis and sepctic arthritis

Answer 19

TS:
ROM- guarded hip rotation
fever- low
ESR- <15
synovial fluid- clear

septic:
ROM- pronounced, spasm, guarding, fixed position
Fever- high
ESR->20
synovial fluid- WBC/bacteria

Question 20

connective tissue do what, made up of what

Answer 20

hold structures of body together, elastin/collagen

Question 21

until what age are kids expected to be hypermobile

Answer 21

3 females, 4 males

Question 22

beighton score for hypermobility

Answer 22

5/9

Question 23

clinical features of hypermobility

Answer 23

joint/muscle pain
fatigue

rolling ankles common

Question 24

what is ehlers danlos syndrome

Answer 24

group of genetic connective tissue disorders

can be autosomal dominant and recessive inherited

it is decrease in tensile strength and integrity of skin, joints andother connective tissues

Question 25

most common type of Ehlers danlos syndrome

Answer 25

hypermobile type 5- only subtype with an unknown genetic basis/protein pathway

Question 26

clinical features of classic/classic like EDS (type 1/2)

Answer 26

skin hypersensitivity
wide, atrophic scars
spheroid formation
joint hypermobility
delay in milestones
hernias due to organ shift

-skin/joints affected

Question 27

clinical features of vascular EDS (type 4)

Answer 27

most severe form
mortality reduced to 50years
acrogeria
thin, pale, transluscent skin
fragile blood vessels/ruptures
high risk during vagina delivery
extensive bruising
facial features charaacteristic

Question 28

clinical fetures of hypermobile EDS

Answer 28

type 5, most common
skin hyperextensibility
dislocations, sublaxations, hyperextension, pes planus
muscle atrophy/weakness
brusing
smooth skin
early onset osteopenia/OA

Question 29

management of EDS

Answer 29

activity moderation
sport technique
footwear mods/devices for stability and offloading
strapping/padding

Question 30

marfans syndrome

Answer 30

autosomal dominant

highest cause of morbitity/mortality from aneurysmal dilation, aortic regurgitation and dissection

Question 31

clinical features of marfans

Answer 31

-excess linear growth of long bones (long thumb for example, wrapping hand around wrist)
-hypermobility
-pectus defomrity
-scoliosis/kyphosis
-facial features (sunken eyes, head width/length ratio, under developed cheekbones)
-ocular abnormalities- colour of eyes
-skin straie
-henrias

Question 32

osteogenesis imperfecta clinical features

Answer 32

brittle bone disease

-fragile bones/osteopenia
-regular factures
-small stature
-blue sclerae
-hearing loss
-brittle teeth
-muscle weakness
-hypermobility

Question 33

what is epidermis bullosa

Answer 33

group of rare genetic diseases of skin causing easy bruising/wounds

elastin/collagen deficiences