Paeds rheumatology

Question 1

JIA definition

Answer 1

Question 2

The key features of inflammatory arthritis are

Answer 2

joint pain, swelling and stiffness.

Question 3

five key JIA subtypes:

Answer 3

Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis

Question 4

Systemic JIA definition and features

Answer 4

Question 5

Systemic JIA investigation findings

Answer 5

Question 6

Key complication of systemic JIA

Answer 6

Question 7

In children that have fevers for more than 5 days, the key non-infective differentials to remember are

Answer 7

Kawasaki disease
Still’s disease (systemic JIA)
rheumatic fever
leukaemia.

Question 8

Polyarticular JIA deifntion and features

Answer 8

Question 9

Polyarticular JIA is the equivalent of … in adults

Answer 9

rheumatoid arthritis

Question 10

Polyarticular JIA investigation findings

Answer 10

Question 11

Oligoarticular JIA definition and presentation

Answer 11

Question 12

Oligoarticular JIA investigation findings

Answer 12

Question 13

Juvenile psoriatic arthritis definition and presentation

Answer 13

Question 14

Juvenile psoriatic arthritis is associated with several signs on examination:

Answer 14

Question 15

Enthesitis-related arthritis is more common in

Answer 15

male children over 6 years

Question 16

Enthesitis-related arthritis is the paediatric version of the… group of conditions that affect adults

Answer 16

the paediatric version of the seronegative spondyloarthropathy group of conditions that affect adults. These conditions are ankylosing spondylitis, psoriatic arthritis, reactive arthritis and inflammatory bowel disease-related arthritis. Patients have inflammatory arthritis in the joints as well as enthesitis.

Question 17

The majority of patients with enthesitis-related arthritis have the… gene

Answer 17

The majority of patients with enthesitis-related arthritis have the HLA B27 gene

Question 18

When assessing patients for enthesitis-related arthritis, consider signs and symptoms of

Answer 18

psoriasis (psoriatic plaques and nail pitting) and inflammatory bowel disease (intermitted diarrhoea and rectal bleeding). Patients with enthesitis-related arthritis are prone to anterior uveitis and should see an ophthalmologist for screening, even if they are asymptomatic.

Question 19

Patients with enthesitis will be tender to localised palpation of the entheses. Therefore it is worth palpating key areas to elicit tenderness of the entheses:

Answer 19

Question 20

Management of Juvenile Idiopathic Arthritis

Answer 20

Question 21

Enthesitis definition and cause

Answer 21

Question 22

…criteria is used to assess the probability of septic arthritis in children using 4 parameters:

Answer 22

Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr

The probabilities are calculated thus:
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis

Question 23

Red flags in MSK symptoms

Answer 23

Question 24

Features to suggest not growing pains

Answer 24

Question 25

4 year old boy Limp and knee swelling for 8 weeks: reduced play stiff in mornings Otherwise well, good appetite, no fever, no pain at night On examination: all joints fine except knee:

Answer 25

Synovitis or arthritis of the right knee --> juvenile idipathic arhtirit

Question 26

Differential diagnosis of a swollen joint

Answer 26

Question 27

Diagnosis of JIA

Answer 27

Question 28

Benign joint hypermobility syndrome management

Answer 28

Disease education Pens, OT help with writing Exercises for muscle control of joints Advice to continue sports

Question 29

Benign joint hypermobility syndrome differentials and what conditions are associated with this

Answer 29

* Need to rule out associated inheritable conditions e.g. Marfan’s syndrome * Ehler’s Danlos syndrome type 3: Other types including life-limiting type 4 (spontaneous vascular accidents)

Question 30

3 year old girl Fever, decreased appetite, miserable Very unwell when hot with transient pink rash Admission to hospital: * IV antibiotics * Full septic screen (? what) * Swollen knee, ankle and fingers noted Fever pattern emerged over a few days to a once a day spike (quotidian). No suggestion that fever stopping with antibiotics.

Answer 30

Systemic JIA

Question 31

Common differential diagnosis for systemic JIA

Answer 31

ALL Neuroblastoma Sepsis/Infection Reactive illness Kawasaki disease

Question 32

Manifestations of Kawasaki disease

Answer 32

Question 33

Kawasaki disease investigations and management

Answer 33