paediatrics rheumatology 2

swelling or 2 of tenderness/pain, limited rom, warmth, px/tender on movement

onset <16yrs, duration>6wks, exlusion of other causes, no diagnostic test

Systemic arthritis (still's- 10%), oligoarthritis (4 or less jts -50%), Polyarthritis (5 or more jts-30%), enthesistis related/seroneg spondlyloarthryopathies, psoriatic arthritis, unclassified

median 10.5 yrs, 39% in remission, 75% of remission occur in 5 yrs, remmisions at 16yrs- pauci (52%), systemic (35%), rfneg (24%), rfpos (0%)

fever, rash (salmon, relates to fever spikes), arthritis, unusual posturing, hepatosplenomegaly, lymphadenopathy, serositis, anaemia, high esr, crp, platelets and ferritin, quotidien fever that returns to baseline, well during periods of no fever or rash, tx is with high dose steroid, mtx, anti tnf

persisten or extended, <5yrs f>m, large jts (esp knee), ana pos in 80%, rf neg, knee flexion contracture, quads atrophy, leg length discrep (initially longer on affected, later shorter), tx with intrart steroids, uveitis most common in this group (20%, assoc with pos ANA, asymptomatc- requires screening, does not parallel disease course)

young f>m, small and large jts, neck, tmj, uveitis in 10%, ana pos in 50%, complications (cervical spine arthritis, tmj arthritis- micrognathia, growth disturbance)

older girls, symmetric small and alrge jt arthritis, rheumatoid nodules over pressure points in 30%, ana may be positive, tx aggressive

older boys>girls, fam hx, peripheral and axial arthritis, absent ANA and RF, early hip disease (only in this group), hla b27 pos, enthesitis, presents with peripheral arthritis cf adult AS

dactylitis, psoriasis, iritis, conjunctivitis, ibd, mouth ulcers

fever, pain, swelling, redness, won't bare weight, px greater that would expect

aspirate and culture, blood culture

slapped cheeks, lacey rash on periph, usually female, assoc with arthiritis, affects hands, wrist, knees and feet

acute rheumatic fever, extremely pxful jts, tx with nsaids

1-3wks post other infection, bacterial or viral "transient synovitis" (2-6yrs old)

systemic (leuk, lymph, neuroblast), local(benign-osteoma, eosinoph granuloma, malig-sarcoma)

fever, wt loss, px>findings, night px, hepatosplen, lymphad, anaemia, xray-metaphyseal lucency

overuse syndromes, perthes, slipped epiph

small vessels, skin (scalp, scrotum) jts, git, kidneys, acute morbidity related to git (bleeding, intersuss), chronic due to renal (esrd <5%)

acture scrotum, acute abd, meningococcal disease, other vasculitis eg PAN

palpable purpura, age<20yrs at dx, bowel angina, granulocytes in vessel wall

not related to malignancy (still have gottrons, nail fold capillaries, hyperintense mri)

f:m 4:1, die of cvd 2ndary to tx, 20% of all sle occurs before 18, dopanmine rash + venous sinus thrombosis, palatal ulceration