Paedi Rheuma

Question 1

What is Juvenile Idiopathic Arthritis (JIA)?

Answer 1

A group of pediatric inflammatory arthritides lasting longer than six weeks and starting before age 16.

Question 2

How is JIA diagnosed?

Answer 2

JIA is a clinical diagnosis.

Question 3

What is a common symptom of JIA?

Answer 3

Joint pain lasting more than six weeks.

Question 4

What is a characteristic feature of the fever in JIA?

Answer 4

High-grade fever (>39°C), spiking once or twice daily for at least two days a week for two or more weeks.

Question 5

What is an early morning symptom of JIA?

Answer 5

Stiffness, especially after waking or periods of inactivity.

Question 6

What can cause reduced mobility in JIA patients?

Answer 6

Pain (during active disease) or joint contractures (in long-standing disease).

Question 7

What skin feature may appear in systemic JIA?

Answer 7

A salmon pink rash.

Question 8

What eye condition is common in JIA?

Answer 8

Uveitis.

Question 9

What joint changes might be seen on physical examination in JIA?

Answer 9

Swelling, erythema, or warmth in affected joints, and reduced range of motion.

Question 10

What blood findings are common in JIA?

Answer 10

Anaemia, thrombocytosis, and leukocytosis.

Question 11

What does a positive rheumatoid factor (RF) indicate in JIA?

Answer 11

RF-positive polyarticular JIA and potentially more aggressive disease.

Question 12

What test can be positive in RF-positive polyarticular JIA?

Answer 12

Anti-cyclic citrullinated peptide antibody (anti-CCP).

Question 13

What lab result may be positive in some JIA patients?

Answer 13

Anti-nuclear antibody (ANA).

Question 14

How is JIA tx?

Answer 14

NSAIDs, particularly Naproxen

Question 15

What is rheumatic fever?

Answer 15

A systemic inflammatory disorder that follows a group A Streptococcus infection.

Question 16

When does rheumatic fever usually develop after a strep infection?

Answer 16

1-5 weeks after a group A Streptococcus infection, usually pharyngitis.

Question 17

Can rheumatic fever develop after infections other than pharyngitis?

Answer 17

Yes, it can also follow a skin infection like cellulitis.

Question 18

What are the diagnostic criteria for rheumatic fever?

Answer 18

Evidence of recent group A Streptococcus infection plus two major criteria or one major and two minor criteria.

Question 19

What are the major criteria for diagnosing rheumatic fever?

Answer 19

• Polyarthritis (80%)
• Carditis (50%)
• Sydenham’s chorea (10%)
• Erythema marginatum (<5%)
• Subcutaneous nodules

Question 20

What are the minor criteria for diagnosing rheumatic fever?

Answer 20

• Polyarthralgia
• Prolonged PR interval
• History of rheumatic fever
• Fever (>39°C)
• Raised inflammatory markers (CRP, ESR)

Question 21

What are some conditions to consider in the differential diagnosis of rheumatic fever?

Answer 21

• Joint symptoms: systemic-onset JIA, reactive arthritis, Henoch-Schönlein purpura
• Cardiac disease: cardiomyopathy, Kawasaki disease, infective endocarditis
• Chorea: Wilson’s disease, adverse drug reactions, Huntington’s disease
• Skin changes: adverse drug reactions, Lyme disease, erythema multiforme

Question 22

What is the treatment for rheumatic fever?

Answer 22

• Penicillin (benzylpenicillin IV or penicillin V oral)
• Aspirin (high-dose, monitor closely)
• Corticosteroids (if severe carditis)

Question 23

What is reactive arthritis (ReA)?

Answer 23

An inflammatory arthritis that usually occurs after gastrointestinal or genitourinary infections.

Question 24

What is the classic triad of symptoms in ReA?

Answer 24

Conjunctivitis, urethritis, and arthritis.

Question 25

How common is the classic triad of ReA?

Answer 25

It is found in approximately one-third of cases and is not required for diagnosis.

Question 26

When do symptoms of ReA usually begin?

Answer 26

Symptoms usually start within 1 to 4 weeks after the onset of the causative infection.

Question 27

What is the most common pattern of arthritis in ReA?

Answer 27

Asymmetrical oligoarthritis, usually affecting the knee.

Question 28

Can ReA present as polyarthritis or monoarthritis?

Answer 28

Yes, ReA can also present as polyarthritis or monoarthritis.

Question 29

What is the mnemonic for the classic triad of ReA symptoms?

Answer 29

"Can’t see, can’t pee, can’t climb a tree/sore knee."

Question 30

What constitutional symptoms may be present in ReA?

Answer 30

Fever, fatigue, and weight loss.

Question 31

How is ReA diagnosed?

Answer 31

It is a clinical diagnosis based on history and examination.

Question 32

What can help support or exclude other diagnoses in ReA?

Answer 32

Laboratory and imaging investigations.

Question 33

What is the first-line treatment for ReA?

Answer 33

NSAIDs.

Question 34

When are corticosteroids used in the treatment of ReA?

Answer 34

Corticosteroids (intra-articular or systemic) are used if necessary.