Rheumatology

Question 1

Juvenile idiopathic arthritis - 5 types

Answer 1

• Auto immune inflammation of joints in a patient u16
• diagnosed where there is arthritis without any other cause

Sx - joint pain, stiffness and swelling

Types:
Systemic/stills
Polyarticular
Oligoarticular
Enthesitis-Related Arthritis
Juvenile psoriatic arthritis

Mx - MDT
- NSAIDs, steroids, DMARDS, biologics

Question 2

Systemic/Stills px and Ix

Answer 2

Type of JIA

• Salmon pink rash, fever, joint pain

Ix - raised inflammatory markers, platelets and ferritin

Question 3

Sx of polyarticular JIA

Answer 3

Polyarticular (rheumatoid in adults) - Inflammation in 5 or more joints

• Pian, stiffness, swelling

Question 4

Sx of oligoarticular JIA

Answer 4

Oligoarticular - <5 joints affected

• Commonly have anterior uveitis and should be referred

*Most common

Question 5

Px of enthesitis related arthritis

Answer 5

Enthesitis-Related Arthritis - common in males over 6

• Encompasses multiple inflammatory conditions - ank spond

Question 6

Px of psoriatic JIA

Answer 6

• Signs of skin changes, finger and nail signs

Question 7

Cx of Ehlers danlos syndrome

Answer 7

• Genetic condition affecting collagen - Causing hyper mobility and connective tissue disorders

**Dominant inheritance

Question 8

Sx of EDS - hyper mobile

Answer 8

• hyper mobility, stretchy skin, soft skin abnormal wound healing - classical and hypermobile EDS
  **Dominant

Question 9

Sx of EDS - skin

Answer 9

• Thin and translucent skin, spontaneous pneumothorax and GI perf - vascular
  **Dominant

Question 10

Ix of EDS

Answer 10

• Rule out marfans
• Beightons score

Question 11

Mx of EDS

Answer 11

• Physio, occupational health, supporting living, follow up

Question 12

Beighton’s score

Answer 12

**Max score of 9

• palms flat on the floor with straight legs - only 1 point
• hyperextend knees
• Hyper extend elbows
• Thumb to forearm
• Hyperextend pinky past 90degrees

1 point for each side of the body

Question 13

What is IgA vasculitis

Answer 13

• Inflammation in vessels and organs that causes a purpuric rash in lower limbs and buttocks
• IgA deposits irritate vessels causing rash which you can feel under the skin

Question 14

Cx of IgA vasculitis

Answer 14

• Triggered by upper airway infection or gastroenteritis in kids

Question 15

Sx of IgA vasculitis

Answer 15

• Joint pain, purpura rash, abdo pain, renal involvement

Question 16

Ix for IgA vasculitis

Answer 16

• full work up
• Routines, CRP, cultures, urine dip, urine creatinine, BP…
• exclude other pathologies

Question 17

Mx of IgA vasculitis

Answer 17

1st - Pain killers, conservative
- Steroids - Renal deterioration or severe pain
- ACE for proteinuria if GFR stable

*Routine monitoring - BP and urine dip

Question 18

What is Kawasaki’s

Answer 18

• Medium sized vessel vasculitis under age of 5
• common in asians

Question 19

Sx of Kawasaki’s

Answer 19

• Strawberry tongue
• Fever more than 5 days, unhappy and unwell child,
• widespread macropapular rash and peeling skin on hands and feet
• Cracked lips, conjunctivitis, C lymphadenopathy
  CRASH and BURN

Question 20

Complicaitons of Kawasakis

Answer 20

Coronary artery aneurysms - screened using echo

Question 21

Ix of Kawasaki’s

Answer 21

• Clinical diagnosis
• urine dip
• echo for screening

Question 22

Mx of Kawasaki’s

Answer 22

• IV Ig to reduce aneurysm risk
• High dose aspirin to reduce clots
• Aspirin avoided usually due to Reyes syndrome in kids

Question 23

Reye’s

Answer 23

• Progressive encephalopathy

Cx - aspirin and virus

• Sudden brain and liver damage

Question 24

<3yo presents with a limp mx

Answer 24

• urgent assessment from paeds