Paediatric Rheumatology Flashcards
(26 cards)
what is the most common arthritis in children?
Juvenile idiopathic arthritis
Acute joint pain in young children is most likely caused by?
self - limiting transient synovitis
What kind of condition is JIA?
autoimmune
- can be exacerbated by environmental causes eg viruses
- genetics
what are the pro inflammatory markers for JIA?
TNF, interleukin 1 & 2.
Symptoms associated with JIA? (how can we pick it up?)
- Arthritis for at least 6 weeks
- Morning stiffness or gelling
- 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
what are some differential diagnoses for JIA?
- Septic arthritis
- Osteomyelitis
- Transient synovitis
- Malignancies i.e lymphoma, neuroblastoma, bone tumours
- Recurrent haemarthrosis
- Vascular abnormalities
- Trauma
others
Clinical signs of JIA?
Swelling: periarticular soft tissue edema/intraarticular effusion/hypertrophy of synovial membrane
- Tenosynovitis (swollen tendons)
- pain
- Joint held in position of maximum comfort range of motion limited at extremes.
what are the 2 types of oligorthritis
persistent = no more than 4 joints affected
Extended - more than 4 joints affected
How to diagnose systemic arthritis
fever - 2 weeks and arthritis of one joint +
- rash
- lymphadenopathy
- hepatomegaly/splenomegaly
- serositis
diagnostic criteria of psoriatic arthritis
arthritis and psoriasis or 2 of the following
- nail pitting, onycholysis , psoriasis in first degree relative, dactylisis
arthritis that contains the HLA-B27 antigen is..?
Ankylosing spondylitis, sacroiliitis with IBD, and acute uveitis are also features
Enthesitis
JIA patterns of onset - oligoarthritic + pauciarticular
= late onset features
negative ANA test
- no extra articular manifestations
- hipe involvement
JIA patterns of onset - oligoarthritic + pauciarticular = early onset
- develop uvititis
- positive ANA
- kneads ankles , hands
- doesn’t affect hip
polyarticular JIA in seropositive - affects what age?
children over 8
polyarticular JIA in seronegative - affects what age?
- more common
- children under 5
Polyarticular JIA clinical features and symptoms
temporomandibular joint injury is common
- systemic manifestations are rare - fever, pericarditis, chronic uveitis
- affects large growing joints
- acute onset
Enthesitis - related JIA has distinguishing features, name some
onset of apolyarithritis/ oligoarthritis in a boy > 8 years
- HLA-b27 positivity
- acute anterior uveitis
- inflammatory spinal pain
- sacroiliac joint tenderness
- Family History
Psoriatic features of onset
HLAb27
- FH psoriasis
- Dactylitis
- onycholysis
Investigation for Arthritis
lab
- plain x ray
- ultra sound
- MRI with contrast
What is the drug treatment for JIA?
disease modifying anti-rheumatic drugs (DMARDS) –methotrexate
NSAIDS
- intra-articular
corticosteroid injections
non-pharmacological treatment of JIA?
Psychosocial - counselling School adjustments Nutrition - address anaemia and osteoporosis - physical therapy - Occupational therapy
Intraarticular steroids(IAS) have greater success in what joint?
Oligoarticular JIA
Biological agents that are used?
Anti TNF
Uveitis is more common In what arthritis?
ANA positive oligo JIA
- all those diagnosed with JIA will be seen within 6 weeks
