Rheumatology Flashcards
(23 cards)
Septic arthritis presentation in a child
Acute fever Joint pain and swelling Ill appearance Irritable Tachycardia Joint effusion Periarticular warmth and tenderness Pain on movement
Investigations for septic arthritis
CRP and ESR - raised
White cells and platelets - raised
US joint
Blood cultures
Management of septic arthritis
Referral to orthopaedics
IV antibiotics
Joint aspiration
Describe slipped upper femoral epiphysis (SUFE)
Displacement of capital femoral epiphysis from femoral neck
Most common hip disorder of adolescence
Associated with obesity
Pain and altered gait
Worse with activity
Management of SUFE
Xray; ice cream slipping off cone
Refer to ortho
Describe transient synovitis
Pain and limited movement hip
Relatively common
3-8yrs
Symptoms <1week
Fever absent or low grade
not unwell looking
US bilateral effusion
Resolves gradually with conservative therapy
Describe perthes
idiopathic avascular necrosis of hip
Insidious hip pain and limp
Pain not relieved by rest or medication
3-12 years, peak 5-7
males>females
Management of perthes
minimal weight bearing
paediatric ortho
Contain head within acetabulum with use of splints
Occasional surgery (osteotomy)
What are symptoms of juvenile idiopathic arthritis?
Arthritis at least 6 weeks
Morning stiffness of gelling
Irritability or refusal to walk in toddlers
School absence or limited ability to take part in physical activity
rash/fever
Fatigue
Poor appetite/weight loss
Delayed puberty
What are differential diagnoses for swollen/painful joint?
Septic arthritis Osteomyelitis Transient synovitis Malignancies Recurrent haemarthrosis Vasular abnorms Trauma
What are signs of JIA?
Swelling; periarticular, soft tissue oedema, intraarticular effusion, hypertrophy of synovial membrane
Tenosynovitis
Pain
Joint help in position of max comfort
Range of movement limited at extremes
What are types of JIA?
Oligoarthritis (<5joints)
Polyarthritis (more than 5 joints) (RF -ve vs RF +ve)
Enthesitis Related Arthritis
Psoriatic arthritis
Systemic onset JIA
Describe enthesitis related arthritis
tendons involved more than joints
DEscribe oligoarthritis vs polyarthritis
Oligo - <5joints
Poly - > 5 joints
Poly is split into RF +ve and -ve (+ve poorer prognosis)
Describe systemic JIA
5-15% of JIA
Unwell Arthritis Intermittent fever >2weeks Salmon pink erythematous rash Generalised lymphadenopathy Serositis Hepatomegaly/splenomegaly High inflammatory markers
Investigations for JIA
Labs (ESR raised, CRP not)
Plain xray
US
MRI with contrast
Treatment for JIA
NSAIDs (short term not long term)
DMARDs
biologic agents
intraarticular and oral steroids
Physio, OT, school discussions
Describe IA steroids in JIA
Efficacious
Greater success in oligoarticular
No long term side effects
What is DMARD of choice in JIA?
Methotrexate
Injectable (most common) or oral
If poor response to IAS in olgio JIA
Blood monitoring
What are biological agents in JIA?
Used if failure to respond DMARD
Anti TNF agents common
Describe uveitis
Associated with JIA
If untreated can become chronic
All children with JIA undergo screening
More common in ANA positive oligoJIA, <5yrs
Rarely symptomatic
Red eyes, headache, reduced vision
Cataracts, glaucoma and blindness if untreated
Treatment of uveitis
Slit lamp examination
All JIA patients seen within 6 weeks diagnosis
Initially topical steroids to reduce inflammation, more severe need systemic steroids
If poor steroid response, DMARD and biologics introduced
What are complications of JIA?
poor growth Osteopenia Localised growth disturbances Micrognathia (TMJ involvement) Contractures Ocular complications
