Rheum Flashcards
Red flags of MSK pain
Fever - acute joint pain and swelling (suspect infection!)
Pseudoparalysis in a single limb (refusal to move due to pain)
Bone pain (esp at night) deep gnawing - suspect malignancy
Stiffness after immobility.
Multisystem symptoms
Slide 6 - add Table to Resource Bible
STEP WaR acronym for MSK pain in rheumatologic disease
Swelling- effusion, synovial/capsular thickening, soft tissue induration
Tenderness- focal bony, tendon, ligament, synovium, allodynia (diffuse hyperesthesia)
Erythema
Pain in motion- try to recreate the symptoms (vs at rest)
Warmth
Range of motion- passive versus active
Slide 22 add to RB
What is the hallmark of inflammatory arthropathy?
Stiffness after immobility.
Kawasaki more prevalent in kids ______
<5yo
Morning stiffness present for _____ and _____ but not _____, ____ or _____
SLE, JIA
Rheumatic fever, Lyme, Gonococcal
TMJ is really only usuallly affected in ____
JIA
________ does not usually have any eye involvement. ___, ___ and _____ do
Rheumatic fever
SLE, JIA, Lyme and Kawasaki.
SLE has a _____ % positive ANA rate, while JIA has a ____% positive rate.
SLE has a _____ RF while JIA has a ____ RF
99%
50%
POs or neg
100% positive.
______ and ______ can lead to erosive arthritis.
JIA and gonococcal.
Your patient has limb pain. What could be the different causes?
Orthopedic - pain associated with increased activity with no major trauma
Reactive arthritis - be preceded by a viral infx, strep or purpuric rash
Mono articular arthritis - pain in hip or LE - consider cancer
Bacterial arthritis - will see fever, leukocytosis, high ESR.
Arthritis of rheumatic fever - migratory and transient, more painful than JIA, rare in <5yo
Lyme arthiritis - resembles oligoarticular JIA.
What are RF and ANA
Antibodies that indicate the presence of a rheumatological or autoimmune disease.
For titres, a bigger number means a ______ disease. Eg: 1:80 titer is _____ a 1:1280
More severe
Not as severe as
What is the most common chorionic arthritis in childhood?
JIA.
JIA is thought to be a result of?
Defects in anti suppressor cell antibodies (TNF).
JIA has 2 peaks:
1-3 years
8-12 years.
But can occur at any age.
Fevers, stiffness, limb length discrepancies, rashes with fever signify ____
JIA
Early JIA _____ lab evidence.
May not have. Many have normal IMs, RF neg and ANA neg.
What are the different categories of JIA?
Oligoarticular (<=4 joints)
Polyauricular (>4 joints) RF negative
“” RF POs
Psoriatic
Enthesitis-Related arthritis. (Enteropathic)
Systemic
Undifferentiated
Characteristics of Oligoarticular JIA and tx
Young kids (age 1-3 onset)
F:M 4:1
Knees > ankles, wrist, elbow, TMJ, c-spine
20% have uveitis
ANA POs in 60%, IM normal or slightly elevated (most have no lab abnormalities)
Growth disturbance with limb length discrepancy
Tx is NSAIDS, IA steroids, MTX
Characteristics of Polyauricular (5 or more joints) JIA + Tx
Symmetric, small and large joints, c-spine and TMJ. Local growth disturbances and articular damage in RF positive.
Onset biphasicc. (1-3 and 9-14),
Elevated IMs and anemia of chronic disease
Tx: MTX and NSAIDs, may require anti-TNF or biologics.
Characteristics and tx of psoriatic JIA
Biphasic onset 2-3 and mid adolescence
F:M 2:1 in younger, 1:1 in older
Asymmetric more Oligoarticular Polyauricular
Small and medium joints,
Psoriasis in 40-60%
Dactylitis, comorbid obesity
Tx MTX, anti-TNF, biologics. Consider anti IL
What is a stand-out characteristic of systemic onset JIA?
Major: a salmon-pink macular rash that comes and goes, arthritis
Minor: hepatosplenomegaly, serositis, arthralgia lasting 2 weeks or longer (in absence of arthritis
Leukocytosis >= 15000 with neutrophilia.
