15. Paediatric Rheumatology Flashcards
(41 cards)
What are the Benign Symptoms of Paediatric Rheumatology?
- Worse with Activity / Better with Rest
- Worse at the end of the day
- If night pain is relieved with simple Analgesia
What are the Benign Signs of Paediatric Rheumatology?
- No Joint Swelling
- No Bony Tenderness
- Normal Strength
- Normal Height / Weight Growth
What are the Red Flag Symptoms of Paediatric Rheumatology, suggestive of a Serious Condition?
- Fever
- Malaise / Lethargy
- Morning Joint Stiffness / Pain
- Night Pain Refractory to Simple Analgesia and Symptomatic during the Daytime
What are the Red Flag Signs of Paediatric Rheumatology, suggestive of a Serious Condition?
- Joint Swelling
- Bony Tenderness to Palpation
- Muscle Weakness
- Fall in Height / Weight Growth Curve
What are the Blood Investigation Findings associated with Paediatric Rheumatology Disease?
- Raised White Blood Cells and Neutrophils
- ESR Elevated - 48 hours after the Inflammation
- CRP Elevated - 6 hours after the Inflammation
- Blood Film - Normal Film does not Exclude Malignancy
- Blood Cultures - 46-80% Osteomyelitis
What are the Investigation Findings associated with Paediatric Rheumatology Disease?
- Plain X-Ray - May be normal early
- Ultrasound - Sensitive in detecting Joint Effusions
- MRI - Sensitive in detecting Early Osteomyelitis / Perthe’s / Inflammatory Disease / Malignancy
- Bone Scan - Sensitive in detecting Early Osteomyelitis
- CT - Useful to Detect Early Bone Changes / Tumours
What is the Epidemiology of Juvenile Idiopathic Arthritis?
- Female>Male - 3:1
- Aetiology is Unknown
- Chronic Inflammation
- Activated T-Cells and Macrophages involved
What are the Different Classifications of Juvenile Idiopathic Arthritis?
- Oligoarticular Juvenile Idiopathic Arthritis - 1-4 Joints:
- a) Persistent
- b) Extended - More than 4 Joints after 6 Months
- Polyarthritis - 5+ Joints in the first 6 Months:
- a) Rheumatoid Factor Negative
- b) Rheumatoid Factor Positive
- Psoriatic Arthritis
- Systemic Onset Arthritis
- Enthesitis Related Arthritis
- Undifferentiated
How does Juvenile Idiopathic Arthritis present?
- Joint Pain / Swelling
- Stiffness - Early Morning / Relieved by Movement
- Abnormal Gait / Movements / Posture / Limp
- Babies / Infants Crying / Irritability
- Regression of Milestones in Infants
- Fever / Rash
- Lymphadenopathy
- Hepatomegaly / Splenomegaly
- Serositis
What is the Medical Differential Diagnosis for Juvenile Idiopathic Arthritis?
- Septic Arthritis
- Reactive Arthritis
- Rheumatic Fever
- Associated with Inflammatory Bowel Disease
- Connective Tissue Disorder - SLE / Hypermobility / Growing Pain
What is the Surgical Differential Diagnosis for Juvenile Idiopathic Arthritis?
- Perthe’s Disease
- Slipped Upper Femoral Epiphysis
- Congenital Hip Dysplasia
- Fracture
- Trauma
- Referred Pain
What is the Malignant Differential Diagnosis for Juvenile Idiopathic Arthritis?
- Leukaemia
- Neuroblastoma
- Primary Bone Tumour
What are the investigations for Juvenile Idiopathic Arthritis?
- Anti-Nuclear Antibodies (ANA)
- HLA-B27
- Inflammatory Markers
- Rheumatoid Factor
- X-Ray / MRI
- MSK Examination of All Joints - not just symptomatic
Note - No Specific Test and Results are often Normal / Negative. This is to Exclude a Differential Diagnosis
What is the Management of Juvenile Idiopathic Arthritis?
- Encourage Normal Activity
- Drug Treatment
- Regular Ophthalmology Review for Uveitis
- Physiotherapy - Including Hydrotherapy
- Occupational Therapy
- Psychology
Note - Do Not Advise Rest / Splints / Crutches …
What is the Drug Treatment of Juvenile Idiopathic Arthritis?
- NSAID’s
- Intraarticular Joint Steroid Injection
- Oral / I.V. Methylprednisolone - Systemically
- DMARD - Methotrexate / Biologics
What are the Poor Prognosis Factors for Juvenile Idiopathic Arthritis?
- Active Disease at 6 Months
- Polyarticular Onset and Course
- Extended Oligoarticular
- Female
- Rheumatoid Factor Positive
- ANA Positive
- Persistent Raised Inflammatory Markers
What are the Complications of Juvenile Idiopathic Arthritis?
- Altered Growth of Limbs
- Scoliosis
- Short Stature
- Joint Damage / Destruction
- Blindness - Untreated Uveitis
- Psychological Effects of Chronic Disease
- Loss of Schooling
What are the Features of Septic Arthritis / Osteomyelitis?
- Fever
- Systemic Upset
- Severe Limitation of Joint Movement
Note - Beware of Subtle Presentation
What Investigations should be done for Septic Arthritis / Osteomyelitis?
- Bloods - FBC / CRP / ESR
- Ultrasound Guided Joint Aspiration
- X-Ray may show signs of Osteomyelitis
What is the Management of Septic Arthritis / Osteomyelitis?
- Urgent Orthopaedic Input
2. May need Washout and I.V. Antibiotics
What are the Features of Trauma?
- History of Trauma
2. Signs of Injury
What Investigations should be done for Trauma?
X-Ray / CT Scan
What is the Management of Trauma?
- Inpatient / Outpatient
2. Management is dependent on the Type / Cause of the Injury
What are the Features of Irritable Hip?
Systemically Well
