RHEUMATIC DISORDERS Flashcards

1
Q

What do we call arthritis that occurs in someone under the age of 16?

A

Juvenile idiopathic arthritis

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2
Q

What is the prevalence of juvenile idiopathic arthritis?

A

1 in 1000 children

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3
Q

What are the main 3 types of juvenile idiopathic arthritis?

A

Systemic (previously called Still’s disease)

Polyarticular

Oligoarticular

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4
Q

What age group is most commonly affected by systemic juvenile idiopathic arthritis?

A

Under 5 year olds

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5
Q

Which joints are primarily affected in systemic juvenile idiopathic arthritis?

A

Both knees, wrists, ankles and tarsal bones.

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6
Q

What are the clinical features of systemic juvenile idiopathic arthritis?

A

Pain in several joints including both knees, wrists, ankles and tarsal bones

High daily spiking fever

Salmon-pink rash

Lymphadenopathy

Hepatosplenomegaly

Malaise and myalgia

Inflammation of pleura and serosal membranes

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7
Q

What are the subdivisions of polyarticular juvenile idiopathic arthritis?

A

Rheumatoid factor negative

Rheumatoid factor positive

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8
Q

How many joints must be affected for juvenile idiopathic arthritis to be classified as polyarticular rather than oligoarticular?

A

More than 4

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9
Q

Is the arthritis in polyarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

A

Symmetrical

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10
Q

What age group is most commonly affected by rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

A

All ages are affected

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11
Q

Which joints are primary affected in rheumatoid factor negative polyarticular juvenile idiopathic arthritis?

A

All joints can be affected.

There is particular limitation in the motion of the neck and temporomandibular joint.

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12
Q

What age group is most commonly affected by rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

A

Girls over the age of 8

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13
Q

Which joints are primary affected in rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

A

Arthritis of the small joints of hands and feet

Hip and knee joints affected early

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14
Q

What are the extra-articular features of rheumatoid factor positive polyarticular juvenile idiopathic arthritis?

A

Rheumatoid nodules on pressure points

Systemic vasculitis

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15
Q

How many joints are affected in oligoarticular juvenile idiopathic arthritis?

A

4 or less

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16
Q

Which joints are primarily affected by oligoarticular juvenile idiopathic arthritis?

A

Knees

Ankles

Elbows

Hips tend to be spared

17
Q

What age group is most commonly affected by oligoarticular juvenile idiopathic arthritis?

A

Girls under 6 years old

18
Q

Is the arthritis in oligoarticular juvenile idiopathic arthritis symmetrical or asymmetrical?

A

Asymmetrical

19
Q

What is typically found on an antibody screen of a child with oligoarticular juvenile idiopathic arthritis?

A

ANA

20
Q

What are the extra-articular features of oligoarticular juvenile idiopathic arthritis?

A

Iridocyclitis (inflammation of the iris and ciliary body)

Anterior uveitis

21
Q

What investigations should be done in a child that presents with signs and symptoms consistent with juvenile idiopathic arthritis?

A

FBC - anaemia occurs in systemic disease

Acute-phase reactants - raised

RF - negative in majority of cases

ANA - oligoarticular

X-ray

22
Q

How do we manage a child with juvenile idiopathic arthritis?

A

MDT approach

Physiotherapy - optimize joint mobility, prevent deformity and increase muscle strength

Medication:

Oligo: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor.

Poly: NSAIDs and glucocorticoid steroid injections. Can be escalated to methotrexate and TNF-alpha inhibitor and then further escalated using another TNF-alpha inhibitor

Systemic: Systemic steroids with escalation to interleukin-1 receptor antagonists