Paediatric Rheumatology

Question 1

What are the symptoms of acute septic arthritis?

Answer 1

Acute onset fever
Joint pain and swelling
Ill appearance
Irritable
Tachycardia
Joint effusion
Periarticular warmth and tenderness
Pain on movement

Question 2

What are the investigations for acute septic arthritis?

Answer 2

Elevated CRP and ESR
Raised white cells and platelets
Blood cultures- often negative
Ultrasound- helpful to identify effusion

Question 3

How is acute septic arthritis managed?

Answer 3

Refer to orthopaedics
IV Abx
Joint aspiration

Question 4

What is the most common rheumatological disease in children?

Answer 4

Juvenile idiopathic arthritis

Question 5

What are the symptoms of juvenile idiopathic arthritis?

Answer 5

Arthritis for at least 6 weeks
Morning stiffness or gelling (improves with movement- opposite of septic arthritis)
Irritability or refusal to walk in toddlers
School absence or limited ability to participate in physical activity
Rash /fever
Fatigue
Poor appetite/wt loss
Delayed puberty

Question 6

What is the difference between oligoarthritis and polyarthritis?

Answer 6

Oligoarthritis affects <5 joints and polyarthritis affects >5 joints

Question 7

What is the differential diagnosis for JIA?

Answer 7

Septic arthritis
Osteomyelitis
Transient synovitis
Malignancies i.e lymphoma, neuroblastoma, bone tumours
Recurrent haemarthrosis
Vascular abnormalities
Trauma

Question 8

What are the signs of JIA?

Answer 8

Swelling- periarticular soft tissue oedema/intraarticular effusion/hypertrophy of synovial membrane
Tenosynovitis (swollen tendons)
Pain
Joint held in position of maximal comfort
Range of motion limited at extremities

Question 9

What proportion of JIA is systemic?

Answer 9

5-15%

Question 10

What are the clinical features of systemic JIA?

Answer 10

Unwell
Arthritis
Intermittent fever >2 weeks
Salmon pink erythematous rash
Generalised lymphadenopathy
Serositis
Hepatosplenomegaly 
High inflammatory markers (ESR, CRP)

Question 11

What investigations are useful in systemic JIA?

Answer 11

Lab tests
Plain X-ray
Ultrasound
MRI with contrast

Question 12

How is JIA treated?

Answer 12

First line- intra-articular steroids
If poor/no response (>3/4 IA steroids needed annually) then give DMARD
First line DMARD is methotrexate
Biological agents can be used if no response to DMARD. This is most commonly an anti-TNF

Question 13

In what kind of JIA is uveitis most common?

Answer 13

ANA positive oligoarticular

Question 14

What are the symptoms of uveitis?

Answer 14

Usually asymptomatic but can cause:
•Red eyes
•Headache
•Reduced vision

Question 15

What are the possible complications of uveitis?

Answer 15

Chronic uveitis
Cataracts
Glaucoma
Blindness

Question 16

How is uveitis treated?

Answer 16

Slit lamp examination
Topical steroids to reduce inflammation
More severe cases will require systemic steroids
DMARD and biologics if poor response to steroids

Question 17

What are the possible complications of JIA?

Answer 17

Poor growth
Osteopenia
Localised growth disturbances
Micrognathia
Contractures
Ocular complications