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15 Cards in this Set

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A 7 year old girl has been complaining of pain & swelling of the left wrist & right knee off & onn for the past 3 months. She has been previously healthy. The pain is worse in the morning & improves throughout the day. Exam is remarkable for swelling & effusion of the right knee, with decreased range of motion
How does a pt with JRA present?
1. morning stiffness, joint pain, & swelling
2. joint is warm & has decreased range of motion
4. LOW-grade fever may be present, as well as malaise
Describe Polyarticular JRA
involves many small joints, especially the hands, & accounts for 35% of all JRA
Describe Pauciarticular JRA
affects fewer but LARGER joints in an asymmetric distribution
-risk for eye involvement = Iridocyclitis
Desribe Systemic JRA
initial Extraauricular manifestations such as FEVER, RASH (especially w/ fever), hepatosplenomegaly, Pleuritis, & pericarditis
What are the first-line drugs for JRA?
Nonsteroidals including Aspirin

Methotrexate is 2nd line
Antimalarials are occasionally used
What follow-up is extremely important in JRA?
What are the characteristics of Kawasaki Disease?
1. Fever is present in ALL cases...does not respond to antibiotics
2. Bilateral nonpurulent conjunctival injection
3. Mucus membrane changes = cracked lips, strawberry tongue
4. Peripheral extremitity changes = edema or erythema of hands or feet, periungual desquamation
5. Rash = truncal, polymorphous, nonvesicular
6. Cervical Lymphadenopathy
What is the treatment for Kawasaki disease?
IVIG & high-dose Aspirin
What 3 things can accompany Kawasaki disease?
1. Thrombocytosis
2. Sterile pyuria
3. Anemia
A 5 year old boy is seen with maculopapular lesions on the legs & buttocks. He complains of ab pain. He has recently recovered from a viral URI. CBC, coagulation studies, & lytes are normal. Microscopic hematuria is present on urine analysis
HSP = Anaphylactoid Purpura
Define HSP
IgA mediated vasculitis of small vessels & is the most common cause of nonthrombocytopenic purpura in children

Capillaries are most frequently involved
Describe the presentation of HSP
-usually precedes URI
-Skin lesions are hallmark = start out as macule or wheal & blanch on pressure -> progress to petechiae -> vasculitis causes a palpable purpuric rash
-rash typically on buttocks & legs
-Edema & arthritis
-GI symptoms = colicky pain, gross or occult blood in stool
-Renal = hematuria, proteinuria, HTN
-CNS rare but can have seizures
What is the therapy for HSP?
Supportive = self-limited

Corticosteroids are used for GI & CNS complications