Paediatric Rheumatology

Question 1

What are the different types of juvenile idiopathic arthritis? (5)

Answer 1

Systemic

Polyarticular

Oligoarticular

Enthesitis-related

Psoriatic

Question 2

How does systemic juvenile idiopathic arthritis present? What is seen on blood tests?

Answer 2

AKA Still’s disease

Salmon-pink rash

High swinging fevers

Lymphadenopathy

Joint inflmmation+pain

Weight loss

SPlenomegaly

Raised ESR and CRP

Raised ferritin, raised platelets

Question 3

What is the most important complication of systemic juvenile idiopathic arthritis?

Answer 3

Macrophage activation syndrome

Severe activation of the immune system

Causes an acutely unwell child, DIC, non-blanching rash

LOW ESR

Question 4

How is juvenile idiopathic arthritis managed?

Answer 4

NSAIDs

Steroids

DMARDs

Biologics

Question 5

What is Henoch-Scholein purpura and what are the four classic features?

Answer 5

A type of IgA vasculitis

1. Purpura
2. Joint pain
3. Abdominal pain (GI haemorrhage, intussusception, bowel infarction)
4. Renal involvement (IgA Nephritis - haematuria, proteinuria)

Question 6

How is Henoch-Schonlein purpura diagnosed?

Answer 6

Need to exclude other more serious causes of purport - meningococcal septicaemia, leukaemia, ITP, HUS

Diagnosis = urine dip, U+E, BP

Question 7

How is Henoch-Schonlein purpura managed?

Answer 7

Mainly supportive

Question 8

What is Kawasaki disease and what are the features?

Answer 8

A systemic medium-sized vasculitis

Persistent high fever (more than 5 days)

Widespread erythematous maculopapular rash

Peeling skin on palms and soles

Strawberry tongue

Cracked lips

Cervical lymphadenopathy

Bilateral conjunctivitis

Question 9

How is Kawasaki disease managed?

Answer 9

High dose aspirin (reduces risk of thrombosis)

IV immunoglobulins (reduces risk of coronary artery aneurysm)

Question 10

What is a key complication of Kawasaki disease?

Answer 10

Coronary artery aneurysm

Needs monitoring with echos