RHEUM Flashcards by Maryam Garkuwa

IDIOPATHIC JUVENILLE ARTHRITIS

<16

Intermittent fever + daily 
transient MP rash usually with fever 
serositis
hepato/splenimegaly 
labs: thrombocyttosi + leukocytosis , anemia , lymphadenopathy

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list types of athriits

REACTIVE
PSORIATIC
JUVENILLED IDOPATHOC
SEPTIC
osteo - not relevant to kids

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how can we classify arthritis

acute and chronic

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cut off point for chronic arthitis

6 weeks

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what/how many fetaures must be presnet for someone to have arthritis

2 of the features of arthitis OR INTRARTICULAR EDEMA

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HOW long should morning stiffness be to be clincally relevant

> 10 minutes

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what cardinal sign of inflammation isn’t really typical for juvenille RA

RUBOR - so if it is then suspect septic of acute rheumatic fever

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what key featureS between RA in kids and septic

septic- won’t be able to weight bear AT ALL

RA- tolerable, they will still get on with their day

sep: dramtic onset within hours/das
ra:more chornic in nature

sep: LOOK ILL_ redness over skin
RA: look fine + skin not red

sep; usually 1 joint!

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night time sympotms in RA

no no no think cancer and bening too like osteoriod osteoma

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which cancers are we thinking bone pain

leukemia and bone cancer

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what is quite relevant in the history of a kid with RA

usually will have a family history of Autoimmune conditions like chornes or diabtes

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chronic osteomyelitis

imgaing for OM

draining sinus tact

mri is amazing for bone
x ray - too ealry to see

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WHAT things should a person NOT HAVE ON PHYSICAL EXAM for Ra

Red joints
fever - unusual?
HSM?- double chek on vn usman
general lymphadenopathy

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how can the eyes become affected in RA

most common location of OM

anterior uveitis - iridicycltiis with formation of syechia which means pupils don’t respond to light

long bones like femur and tibia

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labs for ra

leukocytes should either be normal or high (if low suspect dx)

plt- normal or high - remember plt are a very sensitive pro inflammatory marker

neutrohilia
SHOULD NOT BE LYMPHOCYTOSIS dx leukemia

CRP + ESR (but remember crp is very acute so if this is a chronic or latent phase it can be normal )

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dx for RA

immunodeficiency - because that can cause joint pain and fevers and also because of the treatment! it is contradictory, for RA we need to immunosuppression but we cant give that to a deficient person.

hemophilia - espcially if its a boy who is just starting to walk - do a clotting screen

why do we think about ANA IN RA

because ANA + girls are risk for uveitis so we need to regularly asses every 3 months

ANA - (not such a risk )

what imaging if you suspesct RA which is best

X RAY- need to rule out ewing sarcoma, and other bone cancers like sarcomas esp if its MONOARTCICULA

ultrasoinf of the joint- effusions and synovial hypertoophy

us is best because x ray changes will only be seen after 10 DAYS! osteopenia and reduced joint space !

key buzzwords for RA

osteomyleitis tx

SYNOVIAL HYPERTROPHY
JOINT EFFUSION
INTRA ARTICULAR EDEMA

IV ab for several weeks(until labs are good ) then after swithc to oral fore several weeks

TX RA

-intrarticular if oligo
- iv - if poly

methotrexate -dmards- once a week (remember folic acid)

biolgical therapy
- anti IL-6
ANTI TNF

DEF oligoarthtis

cause of osgood chatlet and signs

<4 joints or 4

osteochrondrtis of patella tendon
pain after exertion and some will have tibual tuberosity swelling

why are we wary of cs

tx of oscgood shatle

because of stunted growth iTS VERY DIFFCULT FOR KIDS TO CATCH UP and the plethora of side effects

physi to strenghten quads, immobilizd

what is the problem with physical exam of septic arthtis in regards to inflammaiton

some of the features will not be vsisable if tis a deep joint like the hip like redness and edema as joint is too

tx for septic

complicatins of SEPTIC ARTHTIRIS

IV! 2 different ones - antistaph drugs
blood cultres

osteomyelitis
osteonecrosis (espcially hip and shoulder joints as head of femur the vessels cant supply blood due to the high pressure so need to make sure you drain joints to decrease the risk of necrosis

most common cause of septic transiet coxitis tx

STAPH More frequently boys up to 4(8) yrs. of age, often following URTI. Well child, afebrile or sub-febrile Limp but able to bear weight with limited internal rotation and extension rest and nsaids THERE CAN BE EFFUSIONS! so drain

leukemia vs juvanelle

leukemia can have low lymphocyes! night pain = leukmia high LDH physical exam look unwell leukemia HSM+ LYMPHADENOPATHY lekmeia on physcial exam usally no evidence of arthritis

joint aspirationc an rule out FAMILIAL MEDITTERRANEAN FETAURES, epidemiology and what would you calsfifcy the illness under

infection and maliganancy! AR, fever, serositis(PAINFUL perionitis, painful chest) arthritis (lower limbs) rash (erysipelas like) , orchitis in between attacks its calm and self remitting colchine to prevent amyloidosis jews, turks armeians its an autoinflammotry disorder (no immune vibes foind)

Complications of RA perthes disease , diagnosis , DX , tx

flexion contractures - will need physio and splinting joint destruction- may need a prosthesis to repair the joint anterior uveitis boys, limp, referred pain to the knee , can result in deformaties! And the child may need to have a splint to keep immbolized D: x ray - SCLEROIS tx: <50% comservative, bed rest, no weight bearing >50% splint, or osteotomy (cut and reshape bone) DX - transiet synovitis as same symptoms but will resolce in 2 weeks, perthes disease is more chronic

slipped capital epihysis , x ray fetaures

Dislocation of the epiphysis of the femoral head posteriorly and inferiorly Overweight boys aged 10-14 yrs (more teens) Associated with hypothyroidism and growth hormone deficiency Diagnosed radiographically; bilateral in 30% Treatment – urgent referral to orthopedics – in the meantime non-weight bearing, immobilization to prevent avascular necrosis, surgery to fix the epiphysis in place with a SCREW postive trendelenberg x ray - widened epihysis, trethowans sign

osteoid osteoma

night time pain, most commonly proximal femur and radiates to the knee! tx, nsaids and surgery to remove x ray- area of lucency surrounded by sclerosis

key word for ex ray leukemia main rf for oschgood schatler

lucent metaphyseal bands!! young active boys who play sports

osteochondritis descinas

pain from avascular necorsis of femoral medial condyle causinf bone and caritalge to seperate common in girls physio to streghtne the quads, and rest

chonadromalcia patella

common in girls softenign of patella cartialge difficut to walk up the stairs and stand from sitting up physio to streghent the quads

gworing pains

doesnt affect mobilty from 3-12 symmterical pain in lower limbs NEVR HAPPENS IN THE IN THE MORING WHEN YOU WAKE UP nomral physical exam