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Flashcards in rheumatology peds continued Deck (13):

what are the most common ages for lupus

very rare before 10. often seen in adolescents, esp. around menarche


what complication is seen in neonates born to moms with lupus

congenital heart block due to transplacental passage of maternal antibodies


SLE diagnostic criteria

1. serositis (pleuritis or pericardial effusion)
2. oral or nasal ulcers
3. arthritis (nonerosive)
4. photosensitivity
5. blood cytopenias
6. renal disease
7. ANA positive
8. anti-dsDNA antibodies or anti-Smith antibodies (smith is even more specific)
9. neuro symptoms (encephalopathy, seizures, psychosis)
10. malar rash
11. discoid lupus


How is SLE managed?

1. immunosuppression. glucocortocoids are mainstay of treatment for kids. cyclophosphamide may also be useful, though it can cause hemorrhagic cystitis, infertility, and secondary malignancies.
2. treat complications:
-anti-coagulation if thrombosis
-renal failure txs


major causes of death in SLE?

infection, renal failure, CNS complications


dermatomyositis: epi and definition

-inflammatory condition of muscule that causes progressive muscle weakness with skin findings
-seen in 5-14 yos most commonly


clinical features of dermatomyositis

constitutional symptoms
-heliotrope rash, which crosses the nasal bridge
-gottron's papules
proximal muscle weakness (esp. hip girdle/legs). gower's sign.
may also have other manifestions (neck weakness, calcinosis, telangiectasias, constipation, dysphagia, cardiac issues)
NOT associated with malignancy in kids


treatment of dermatomyositis

vitamin D and Ca to repair osteopenia


what are the main complications of dermatomyositis?

-aspiration PNA
-intestinal perforation
-osteopenia (often d/t steroids)


clinical features of rheumatic fever

cardiac involvement: endocarditis (most common), often of left sided heart valves; myocarditis (tachy out of proportion to fever), pericarditis (rare)
polyarthritis: migratory, asymmetric. no long-term jt disease
syndeham's chorea
-erythema marginatum: pink-red macules which coalesce and spread centripetally with central clearing
officially diagnosed with jones criteria


labs in rheumatic fever

antistreptolysin-o titers usually high- suggest recent strep infection
anti-DNase and anti-hyaluronidase


tx rheumatic fever

-penicillin for strep
-NSAIDs for joint pain AFTER diagnosis has been established
-steroids if cardiac disease is severe
-haldol for sydenham's chorea


treatment of lyme disease

early disease or late disease with arthritis only is treated with doxycycline if >9, or amoxicillin
carditis and menigitis require IV ceftriaxone or penicillin