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Year 3 Paediatrics > 27. Rheumatology > Flashcards

27. Rheumatology Flashcards

1
Q

How does septic athritis present?

A 
Acute onset fever
Joint pain and swelling
Unwell appearance 
Irritable
Tachycardia
Joint effusions
Periarticular warmth and tenderness
Pain on movement
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2
Q

What will you see when yiu investigate a childhood JIA?

A

Elevated CRPand ESR- markedly raised
Raised white cell and platelets
Blood cultures results- typically negative
Ultrasound d helpful to see effusions

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3
Q

How do you manage a child with septic athritis?

A

Empiral intravenous antibiotics
Joint aspiration
Refer to orthopaedics

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4
Q

What is SUFE?

A

Slipped upper femoral epiphysis

Displacement of the capital femoral epiphysis
Most common hip disorder of the adolescence
Associated with obesity
Pain and altered gait
Worse and activity

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5
Q

How does transient synovitis present?

A 
Pain and limited movement in the hip
Relatively common
Etiology unclear
3-8 years age group
Symptoms <1 week
Fever absent or low grade
Not unwell looking
Us bilateral effusion
Resolves gradually with conservative therapy
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6
Q

What is perthes?

A

Idiopathic avascular necrosis of the hip

Resents as insidious hip pain and limo
Pain not relieved by rest or medication
3-12 years peak 5-7 years
Bilateral 10-20% 
M:F 3-4:1
Etiology undefined
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7
Q

How do you manage perthes?

A

Refer to ortho
Minimal weight bearing
May use splints to contain the head of the acetabulum with the use of splints
Occasional surgery

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8
Q

What should you watch out for with the acute limping child

A

Non accidental injury (abuse)

Malignancy- waking up and unresolved crying at night

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9
Q

What is juvenile idiopathic athritis

A

Most common chronic rheumatologic disease in children
Immune response with pro-inflammatory markers
Presentation on antibodies

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10
Q

What are the symptoms of JIA

A 
Athritis of at least 6 weeks (more long term than others)
Morning stiffness or telling
Refusal to walk in toddlers
School absence or limited physical activity participation
Rash/fever
Fatigue
Poor appetite and weight loss
Delayed puberty
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11
Q

What are the different types of JIA?

A

Oligo athritis- less than 5 joints
Polyarthritis (RF+ve)- poor prognosis - RA
Polyarthritis (RF-ve)
Enthesitis related arthritis- tendons over muscles
Psoriatic athritis- related to psoriasis
Systemic onset- Stills disease

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12
Q

What do you look for in JIA?

A 
Swelling
Tenosynovitis- (swollen tendons)
Pain
Joint held joint of maximum comfort (joint will get stuck unless treated)
Range of motion limited at extremities
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13
Q

What is the takeaway in this lecture

A

Septic athritis- BIG RED HOT ANGRY JOINT (typically one joint)

JIA- swelling, maybe slightly red (almost always multiple joint for weeks and weeks)

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14
Q

What are the symptoms of systemic JIA?

A 
Unwell
Athritis
Intermittent fevers> 2 weeks (fever very intermittent, different to septic)
Salmon pink erythematous rash
Generalised lymphadenopathy 
Serostis - inflammation of serosal tissues (heart) 
Hepatomegaly/splenomegaly
High inflammatory marker
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15
Q

How do you investigate JIA?

A

Labs
Plain X-Ray
USS
MRI with contrast

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16
Q

What occurs in inflammatory markers in JIA vs septic athritis

A

JIA only one is raised- maybe ESR?

Septic athritis- both are severely

17
Q

What are the phramacological treatments of JIA?

A

NSAIDS- short term
DMARDS- disease modifying
Biologics

18
Q

What other treatments are their for JIA?

A

Physio
Nutrition
Return to school
Occupational therapy

19
Q

What are intraarticular steroids?

A 
Steroids injected into the joint
Good treatment
Greater success in oligoarticular athritis
Safe and effective
noo long term side effects
20
Q

Discuss DMARDS?

A

Methotrexate- very common
Poor response to intraarticular steroids in oligo JIA
Give early for good outcome

21
Q

What are the biological agents used?

A

Anti TNF therapy
Good safety profile
Newer biologics

22
Q

What is one of the major complications of JIA

A

Uveitis! Swelling of the uvela

23
Q

How do you treat uveitis in JIA?

A 
Treat!
Can be unsymptomatic
Undergo screening
More common in ANA over JIA
Symptoms include red eyes,headaches, reduced vision, glaucoma and blindness
24
Q

How do you treat uveitis?

A

Need slit lamp investigation
Topical steroids to reduce inflammation
More severe need systemic steroids
DMARD and biologics

25
Q

What are the complications of JIA?

A 
Poor growth
Osteopenia- bony erosions
Localised growth disturbance 
Micrognathia
Contracture
Ocular complications

Year 3 Paediatrics (42 decks)

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