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Flashcards in Pediatric Rheum Deck (63):
0

chief compplaint in kids with arthritis

not pain- usually parents notice change ina ctivity

1

milestones in peds to look for

weight and height retradtation
localized growth abnormalities
delayed secondary sex characteristics
going forward than regressing

2

how to evalute a patient

limited ROM-->swelling/tenderness?-->symmetry?

3

benign juvenile hypermotility syndrome

some have painw with this and others dont

4

JI-JA overview

chronic arthritis persisting in >1 joint for >6 weeks at age <16 with exlcusion of other etio

5

pauci-oligo articular age 2-5 years

F>>M
knee, ankle, wrist
ANA +
most severe

6

pauci-oligo articular 6-10 years

F=M

7

pauci-oligo articular age 11-18 years

M>>F
lower limb, enthesitis, acute uveitis

8

enthetitis

inflammation where ligaments or tendons join to bones

9

polyarticular 2-5 years old

F>M
small and large joints with tenosynovitis

10

polyarticular 6-10 years

F>M

11

polyarticular 11-18 years

F>>M
symmetric
RF+
erosive, like adult RA

12

systemic all ages groups

M=F
fever, rash,v araible arthritis, hematologic elevated ESR/CRP, auto ab -

13

lab values in JIA

high platelets
Iga deficient in 7-10%
anti CCP antibody is occasionally seen in kids

14

pathogenesis of synovitis

villous hyperplasia of synovium w/ hypervascularity and infiltration by lymphocytes and macrophages

15

main presentation JIA

younger boy or girls with less than 5 joints

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main symptom

synovitis

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other symptoms

synovitis, joint contracture, +/- erosions, deformity, and functional limitations

18

systemic onset JIA shows

rash +/i enlarged lymph nodes
rash very diagnostic for JIA
rash/fever last 2-5 hours and the arthritis resolves as it does

19

more severe rash in JIA

koebner phenomenom- linear skn lesiosn at site of trauma

20

epiphyseal overgrowth

inflammation at joint stimulates growth of its spiphyseal plate-->affected limb become slonger than the other side until its epiphyseal plate closes early-->ok limb over grows it
(smaller joint is the involved joint)

21

cspine may be associated with

micrognathia (lower jaw smaller than normal)

22

highest risk of uveitis

kids <7 with + ANA, oligoarticular

23

uveitis is usally

asymptomatic-->if undetected, blindness- keratopathy, cataracts

24

tx uveritis

ocular steroids

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tx of JIA

NSAIDs 1st line- covers all signs and symptoms in 30%
refractory cases- 1 injection of sterioids-->stop dz

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systemic JIA

mTx, lefunomide, then biologics if they dont work

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percentage that goes into remission in adulthood with JIA

65% pauciarticualr

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percentage pauciarticular contineu to have active arthritis

50%

29

population most likely to have active arthritis in adulthood

16 year old girls with + RF

30

what do you need to exclude before dx pauci aritcualr 2-5 years

lyme arthritis

31

m&m with systemic onset by age 15

14%, but 80% will achieve adult remission

32

MC raynaud's disease

ADD meds

33

how do you tell primary and secondary raynaud's

+ANA and nailfold path

34

causes of secondary raynaud's

CT disease
occlusive arteriole
vascular injury-frostbite, trauma
drugs and toxins

35

drugs and toxins

b-blockers
vinyl chloride
ampetamine
ritalin/concerta

36

chillblain's is like

reverse raynauds==> venules instead of arterioles (pool blood in toes vs fingers)
*mostly benign

37

how does chillblain's come about

infectious skin condition presenting secondar to exposure to cold as PRURITIC and or painful erythematous to violaceous papules/plaques/nodules

38

autoimmune diseases kids get

raynauds
morphea
neonatal lupus
vasculitis
HSP
kawaski's

39

other name for morphea

linear scleroderma

40

tx for morphea

mild lesions do not require or respond to tx (may regress spontaneously)
-->lesions on face or joint line, treat aggressively (MTX)

41

how do you get neonatal lupus

mother with active SLE can pass Ro and La abs to baby via placenta

42

what does neonatal lupus present as

reversible skin rash, leukopenia, cytopenia

43

big issue with neonatal lupus

irreversible heart bock

44

management of neonatal lupus

cleck SLE mom for these antibodies
if yes, give dexamethasone

45

2 most common forms of vasculitis in children

Henoch schonlein Purpura
kawaski disease

46

when does HSP present

generally after age 3 (slight male predominance)

47

what vessel does HSP infiltrate

capilarries and pre and post cap vessels

48

what is HSP often preceded by

URI

49

pathogenesis of HSP

IgA immune complexes

50

skin findings of HSP

urticaria (hives) to purpura

51

joint clinical presentation of HSP

transient asymmetric arthritis (almost NEVER involves the hips)

52

clinical presentation of GI in HSP

colicky abdominal pain, bloody diarrhea, melena, intususception

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renal clinical presentation in HSP

micro/gross hematuria, proteinura, htn, nephrotic syndrome-->renal failure

54

tx HSP

usually self-limiting and resoloves without sequelae
tx- supportive-hydration and time, meds only if severe disease or if theres suspcision of complx (renal dz)

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kawaski's dz aka

mucocutaneous LN syndrome

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kawaski's disease presentation

generalized systemic vasculitis, but has predilection for coronary arteries-->aneurysms in 20-25% of untreated patients with mortality of 2%

57

tx kawaskis

Aspirin + iViG -->reduces aneurysms to 5%

58

2 proposed mechanisms of kawaski's

polyclonal superantigen response
oligoclonal response (IgA)

59

dx criteria of kawaski's

fever + 4/5

bilateral conjunctival injection
polymorphous erythema rash
oropharyngeal involvement- STRAWBERRY TONGUE
cervical lymphadenopathy
extremity involvmeny

60

extremity involvment of kawaski's includes

edema of hands and feet
erythema of palms or soles
cutaneous desquamation
transverse nailg rooves

61

incmplete/atypical KD

fever >5 days and <4 cardinal signs

62

to confirm dx of KD or atypical KD

echo