Rheumatic And Vasculitic Disorder Flashcards
(30 cards)
JIA:
Criteria for Diagnosis
1-Age onset 2of the following: limited ROM, tenderness, pain on motion, increased heat one or more joints.
3-Duration at least 6 weeks
4-Exclusion of other form of arthritis
5-Onset type by disease presentation in first 6 months .
JIA:
Clinical presentation
1-Morning stiffness 2-Easy fatigability 3-Joint pain later in day 4-Joint warm, pain on motion, No erythema
JIA
Differential Diagnosis
1-SLE 2-Juvenile dermatamyositis 3-Sarcoidosis /Scleroderma 4-Vasculitis 5-Autoimmune hepatitis 6-Late Lyme disease 7-Lymphoproliferative disease
JIA
Category of Disease by Onset ?
1-Paucarticular
2-Polyarticular
3-Systemic
Paucarticular ?
1-< 5 joints
2-Lower extremity; never hip
3-Larg joints
Polyarticular ?
1-_> 5 Joints
2-Larg and small joints
3-Resembles onset in adult
4-Rheumatoid nodules on extensor surfaces of elbow and Achilles’ tendon
Systemic?
1-Arthritis and prominent visceral involvement
-Hepatospleenomegaly
-Lymphadenopathy
-Serositis
-Iridocyclitis
2-Daily t٥ spikes at least 39 for 2 weeks
3-Salmon-coloured evanescent rash
JIA
Labs?
1-ANA ( younger girls )
2-RF+ ( older girls )
JIA
Management ?
1-NSAID
2-Methotrexate
3-Corticosteroid
-Overwhelming inflamation
-Systemic illness
-Bridge therapy
4-Physical therapy / ophthalmologySLE
Clinical presentation
1-Onset > 8years female
2-Fever, fatigue, arthralgia, arthritis, rash
3-Malar rash, discoid, livedo reticularis, Raynaud phenomenon
4-Renal : GN, nephrotic syndrome, renal failure .
SLE
Cardiologic comlication
- Pericarditis
- Libman-Sacks endocarditis,
- Cardiomegaly
SLE
Pulmonary complication
Pleuritic pain, hemorrhage
Serositis
SLE
Criteria for diagnosis
Requires 4/11 1-Malar rash 2-Discoid rash 3-Serositis. 4-Oral ulcers 5-ANA+. 6-Photosensitivity 7-Neurologic disorder 8-Hematologic disorder 9-Arthritis 10-Immune disorder( anti-DNA, smith) 11-Renal disorder
SLE
Lab
- Best screen : ANA
- Best test : Anti ds-DNA ( Active disease )
- Anti-Smith Ab: no disease activity
SLE
Management
1-NSAID : for arthritis ( no renal ) 2-Hydroxychloroquin-mild disease 3-Anticoagluant 4-Corticosteroid : kidney acute 5-Cyclophosphamide : sever disease
Kawasaki
Definition
Acute Vasculitis of medium sized arteries ( coronary)
80% of < 5 years age
Kawasaki
Criteria
Fever _>5 days + 4/5 of : 1-Bilateral nonpurulent conjunctival injection 2-Mucous membrane changes: -Injection pharynx; red dry cracked lips; strawberry tongue 3-Peripheral extremity changes : -Edema/erythema desquamation 4-Rash 5-Cervical lymphadenopathy >1.5cm
Kawasaki
Cardiac findings
1-Early-myocarditis in half, tachycardia , decreased ventricular function
2-Pericarditis
3-Coronary artery aneurysm in 2-3 week
Kawasaki
Lab
1-Platelet high to normal first week , later more than million
2-Normocytic anemia
3-Increased hepatic enzymes
4-CSF pleocytosis
Kawasaki
Treatment
1-IVIG
2-High dose ASA
3-Steroids ( persistent fever )
4-Warfarin
HSP
Definition
1-Ig-mediated Vasculitis of small vessels
2-Most common cause of nonthrombocytopenic purpura in children
3-After URI
3-2..8 years
4-Winter
5-Males > females
HSP
Clinical
1-Pink maculopapular rash progresses to petechia and purpura over 3-10 days ; under waist 2-Arthritis 3-GI : abdominal pain , occult blood 4-Renal 5-Hepatospleenomegaly
2-
Child with limp
- Birth-3years: developmental dysphasia of the hip
- 4-12 Years: Leg-Calve-Perthes disease ( Idiopathic avascular necrosis of the capital femoral epiphysis )
- > 12 Years: Slipped Capital Femoral Epiphysis ( ice cream cone)
- Transient Synovitis : 7-15 days after URI.
Intoeing
1-Metatarsus adductus
2-Clubfoot ( can’t get heel flat on exam surface )
3-Internal femoral torsion ( _>2 years w sitting ) , surgery if more than 10 years
4-Internal tibial torsion : < 2 years
Resolve by 12 months
