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33 Cards in this Set
- Front
- Back
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What do you need to diagnose JIA?
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age of onset < 16 years
duration of arthritis > 6 weeks meet arthritis def'n exclude other causes |
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What is the definition of arthritis?
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presence of a joint effusion
OR presence of 2 or more: -heat -loss in ROM -tenderness or stress pain |
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What must you exclude to call it idiopathic juvenile arthritis?
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infection
trauma post-infection malignancy connective tissue disorder mechanical condition bleeding disorder |
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What type of malignancy will kids present with when complaining of MSK pain?
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leukemia
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What will kids with leukemia present with?
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they will look sick
they will have night pain that wakes them |
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What are the JIA subtypes?
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oligo
poly +/- systemic psoriatic entethesis |
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Hx: 3 yrs old, swollen knee, limps in morning, no injury, otherwise ok
Px: afebrile, looks well, warm right knee, effusion, slight limp, abn pupil (irregular) Diagnosis? |
oligoarthritis
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What is the irregularity we see with uveitis?
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a non-round pupil
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Describe oligoarthritis
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4 joints or less
most common type more girls peak onset 2 to 4 years large joints: knee, ankle, elbow, wrist no systemic illness |
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What is never affected in oligoarthritis?
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hips!
...and the ESR might be normal |
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What is my weird mnemonic for oligoarthritis?
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they're ALL GO and they aren't hip
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Hx: 5 year old girl, stiff gait in morning, red puffy knuckles, no pain
Px: looks well, swollen red hands Diagnosis? |
-polyarthritis (RF -ve)
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What is polyarthritis (RF -ve)?
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5 or more joints
two peaks 5 to 6 then 10 to 12 large joints OR small joints asymmetric or symmetric more girls |
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What joints are affected in RF -ve polyarthritis?
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c-spine
TMJ large joints small joints |
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What is unique about RF +ve polyarthritis?
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same as RF -ve
RF +ve test symmetric disease small joints nodules erosive |
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Hx: 6 month girl, 3 wks of spiking fevers, irritable, rash that comes and goes
Px: unwell, pale, diffuse pink rash, big spleen, swollen wrists and ankles Diagnosis? |
systemic idiopathic juvenile arthritis
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What is DIFFERENT about systemic juvenile arthritis?
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lots of extra-articular signs and sx
no age or sex predominance |
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What are the extra-articular signs in systemic JIA?
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spiking fevers
serositis rash big spleen big lymph nodes myocarditis |
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The patient has a once or twice daily spike in fever that comes down to normal or subnormal. What can this help diagnose?
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systemic JIA
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If a fever spikes, but then doesn't come down to normal, what might it be?
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sepsis
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What is the most important thing to remember about the rash in systemic JIA?
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it is evanescent: it comes and goes
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Hx: 13 yr old boy, swollen knee and ankle, heel pain and stiffness in morning. Dad has ankylosing spondylitis
Px: looks well, effusions, warm tender red joints. Limp. Enthesisits. Bilateral red eyes Diagnosis? |
Enthesitis related arthritis
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What is enthesitis related arthritis?
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arthritis and tendon inflammation
more boys late onset childhood ACUTE uveitis (symptomatic) LOWER extremities (spine, hip, SI joint) heel, foot, knee involvement for enthesitis |
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Acute eveitis versus asymptomatic uveitis. Use to differentiate arthritis. The former might be _________ while the latter is ________.
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enthesitis
oligoarthritis |
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In what type of JIA might you find the hip involved?
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enthesitis related arthritis
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Hx: 3 yr old girl, swollen painful finger, scaly red knee rash
Px: psoriasis on knees, sausage finger and toe Diagnosis? |
psoriatic arthritis
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What is juvenile psoriatic arthritis?
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more girls
two peaks: 2 to 4 and 9 to 11 early onset = oligoarthritis (+uveitis) psoriasis (key to diagnosis) nail pits, sausage |
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What is the remission rate for JIA?
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50%
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What is the prognosis for JIA?
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oligo - best
systemic and RF +ve is worst |
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In what systemic disease in kids do we use hydroxychloroquine?
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SLE
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What is the diagnosis of Kawasaki?
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fever plus 4 or 5 of:
-bilateral conjunctival -cervical adenopathy -red lips, strawberry tongue -puffy feet, red palms/soles, peeling of fingertips -rash (big nodes) |
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What is the treatment for Kawasaki?
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IVIg + high dose ASA
THEN low dose ASA to prevent clotting |
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Why treat Kawasaki?
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if you get them in the ACUTE phase (w/in 6 days of fever) then you can prevent coronary artery abn
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