Paeds Rheumatomolgy Flashcards by Laura I

DDx of limp/joint pain toddler 1-3 yrs

Transient synovitis
Juvenile Arthritis 
Trauma
Growing pain
Child abuse
Developmental dysplasia of the hip
Malignancy
Neuromuscular disease
Referred pain
Haemophilia
Henoch schoenlein purpura
Autoimmune

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DDx of limp/joint pain child 4-10 yrs

Transient synovitis
Juvenile arthritis 
Trauma
Growing pain
Perthes’ disease
Rheumatic fever
Associated with IBD
Malignancy
Referred pain
Haemophilia
Henoch-Schoenlein purpura
Autoimmune

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DDx of limp/joint pain adolescent 11-16 yr

Slipped upper femoral epiphysis
Juvenile arthritis 
Trauma Mechanical(hypermobility)
Associated with IBD
Malignancy
overuse syndromes
Autoimmune

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points to consider while Hx taking in joint pain in kids

Age
Mode of onset (acute or insidious)
Any previous episodes of joint pain
Current or preceding illness or injury
Location, pattern, and duration of pain
Joint swelling, fever
Recent travel

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benign symptoms of joint pain in kids

Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia

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benign signs of joint pain in kids

Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia

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red flag symptoms suggestive of serious conditions in kids joint pain

Fever
Malaise/lethargy
Morning joint stiffness or pain
Night pain refractory to simple analgesia and symptomatic during the daytime

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red flag signs suggestive of serious conditions in kids joint pain

Joint swelling
Bony tenderness to palpation
Muscle weakness
Fall in height or weight growth curve

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investigations of joint pain in kids: bloods

Raised WBC and Neutrophils
ESR Elevated 48 hours after the inflammation
Sensitivity high
CRP Elevated 6 hours after inflammation
Blood film: Normal film does not exclude malignancy-
bone marrow aspirate required
Blood cultures: 46-80% osteomyelitis
22-50% septic arthritis

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investigations of joint pain in kids

plain radiography
USS
MRI
bone scan
CT

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USS in joint pain in kids

sensitive in detecting joint effusions

absence of effusion makes septic arthritis unlikely

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MRI in joint pain in kids

very sensitive in detecting early osteomyelitis, Perthe’s, inflammatory disease and malignancy

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bone scan in joint pain in kids

very sensitive in identifying early osteomyelitis

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CT in joint pain in kids

useful to detect early bone changes and tumours, early fractures.
Significant exposure to ionizing radiation

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septic arthritis/osteomyelitis in kids: features

fever
systemic upset
severe limitation of joint movements
beware of subtle presentation

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septic arthritis/osteomyelitis in kids: investigations

FBC
CRP
ESR
USS and guided aspiration
X-ray

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septic arthritis/osteomyelitis in kids: managemen

urgent ortho input

may need joint washout and IV antibiotics

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joint trauma in kids: features

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history of trauma

signs of injury

joint trauma in kids: investigations

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x-ray/CT

joint trauma in kids: management

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in or outpatient depending on the cause and type

irritable hip in kids: features

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systemically well

irritable hip in kids: investigations

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FBC
CRP
ESR

irritable hip in kids: managment

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advise regular analgesia for 48 hrs

follow up in 7-10 days

Henoch-Schoenlein purpura: features

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purpuric rash
abdo pain
haematuria

Henoch-Schoenlein purpura: investigations

urine dipstick and microscopy | BP

Henoch-Schoenlein purpura: management

paeds referral and follow up

haemarthrosis: features

if spontaneous or after minor injury consider haemophilia

haemarthrosis: investigations

coagulation studies

haemarthrosis: management

if clotting abnormal paeds referral

rheumatic fever: features

``` carditis erythema marginatum mograting polyarthritis subcut nodules chorea ```

rheumatic fever: investigations

``` ECG/ECHO FBC U+E CRP ESR ASOT DNase B ```

rheumatic fever: management

refer to paeds

serum sickness: features

hx of medication use | rash

serum sickness: investigations

``` FBC U+E CRP ESR ASOT DNase B ```

serum sickness: management

follow up in 7-10 days

reactive arthritis: features

hx of recent viral illness | well child

reactive arthritis: investigations

exclude septic arthritis

reactive arthritis: management

follow up in 7-10 days

JIA DDx medical

``` Septic arthritis Reactive arthritis Rheumatic fever Associated with IBD Connective tissue disorder: (Systemis Lupus,Juvenile Dermatomyositis, Connective tissue disorder) Mechanical joint pain(hypermobility) Growing pain ```

JIA DDx malignancy

leukaemia neuroblastoma primary bone tumour

JIA DDx surgical

``` Perthe's disease Slipped upper femoral epiphysis Congenital hip dysplasia Fracture Trauma Referred pain ```

management of JIA

``` Encourage normal activity Drug treatment Regular ophthalmology review for uveitis screening. Physiotherapy, including hydrotherapy Occupational therapy Psychology Family School / peer group ```

poor prognostic factors in JIA

``` Active disease at 6 months Polyarticular onset and course Extended oligoarticular Female Rh Factor +ve ANA +ve Persistent raised inflammatory markers ```

complications of JIA

``` Altered growth of limbs Scoliosis Short stature Joint damage / destruction Blindness(untreated uveitis) Psychosocial effects of chronic disease Loss of schooling ```

Paeds Rheumatomolgy Flashcards

(44 cards)