Term
| what are the three types of JIA, what distinguishes them, what is their prevlence |
|
Definition
systemic: systemic symptoms 20%
polyarticular: >5 joints involved 35%
pauclarticular: <5 joints involved |
|
|
Term
| what are the two categories of symptoms involved in JIA |
|
Definition
| articular and extra articular |
|
|
Term
| what are the 11 conditions in the ddx for JIA |
|
Definition
septic arthritis
lyme disease
osteomyelitis
viral arthritis
growiing pains
pain syndrome
dermatomyositis
henoch-schonlein purpura
kawasaki syndrome
systemic lupus erythematosis (SLE) |
|
|
Term
| what is the most important symptoms of all JIA |
|
Definition
| chronic non-suppurative inflammation of the synovium |
|
|
Term
| what is the prognosis of JIA |
|
Definition
|
|
Term
|
Definition
|
|
Term
| if i were to look at the joint of someone with JIA what would i see (10) |
|
Definition
synovial edema
inflammation
joint effusions
pannus formation
articular surface destruction
deformity
subluxation
tenosynovitis
myositis
demineralization |
|
|
Term
|
Definition
| abnormal granulation tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| inflammation of the sheath around the tendon |
|
|
Term
|
Definition
| inflammation of the muscles |
|
|
Term
| when a patient with JIA comes into the office what symptoms are they going to tell you about their joints (7) |
|
Definition
ankylosis
morning stiffness
weather exacerbations
arthralgia
decreased motillity (cannot fully extend)
tenderness
weampth |
|
|
Term
|
Definition
|
|
Term
| what are 7 abnormal lab findings in someone with JIA |
|
Definition
increased ESR, CRP, platelets, rheumatoid factor, antinuclear antibodies, WBC (leukomoid levels)
low HB (anemia) |
|
|
Term
| what does the synovial fluid look like in someone wih JIA |
|
Definition
| cloudy and stringy without puss |
|
|
Term
| what are 4 lab abnormalities in JIA synovial fluid |
|
Definition
increased protien - not as much as puss
increased cells (5000-8000) mostly PMN
glucose low or normal - not as low as septic arthritis
complement levels low or normal |
|
|
Term
| what do you see on an x-ray from someone with JIA (6) |
|
Definition
soft tissue swelling
demineralization: osteroperosis, thinning
periostitis
epiphyseal thickening and closure
AA sublxation
sacrolitis |
|
|
Term
| why are sports a concern for kids with JIA |
|
Definition
| AA subluxaton, always check |
|
|
Term
| what are the 11 treatments for JIA, which are preferred |
|
Definition
asprin or NSAID - preferred
gold salts
antimalarials
D-penicillnine
methotredate- second place
IVIG systemic corticosteroids
TNF
NEEDED: physical and occulational therapy for swollen joints |
|
|
Term
| why does someone with JIA need physical and occupational therapy |
|
Definition
|
|
Term
| what are the side effects of asprin as JIA therapy (3) |
|
Definition
| gastritis, hemorrhage, RYE'S SYNDROME (occurs in kids <18 yo) |
|
|
Term
| what are signs of asprin toxicity (3) |
|
Definition
| hyperventilation, drowsiness, tinnitus |
|
|
Term
| what are the side effects of NSAID use for JIA (3) |
|
Definition
| gastritis, liver toxicity, renal toxicity |
|
|
Term
| why would you use methotrexate for JIA |
|
Definition
| if not controlled by NSAID or asprin |
|
|
Term
| what are the side effects of methotrexate (3) |
|
Definition
| marrow supression, GI upset, hepatoxicity |
|
|
Term
| why would you use systemic corticosteroids for JIA |
|
Definition
| if you have eye involvement or the systemic type of JIA |
|
|
Term
| what is the downside of systemic corticosteroids for JIA |
|
Definition
| supress symptoms but not joint destruction |
|
|
Term
| what are the additional signs someone with systemic JIA would have |
|
Definition
hectic fever
rash
irritability
arthritis with visceral involvement
maculopapular rash
hepatosplenomeagly
hyperbilirubenia
leukocytosis
anemia |
|
|
Term
| what type of visceral involvement is there in systemic JIA (3) |
|
Definition
| serositis, pleuritis, pericarditis |
|
|
Term
| describe the rash in systemic JIA |
|
Definition
irregular borders
red
central clearing
on trunk and extremities |
|
|
Term
| describe the hectic fever involved in systemic JIA |
|
Definition
| 1-2 spikes per day and chills in the afternoon |
|
|
Term
| what is the main complication of systemic JIA |
|
Definition
| macrophage activating syndrome |
|
|
Term
| when does polyarticular JIA usually show up |
|
Definition
|
|
Term
| what are some signs specific to polyarticular JIA (3) |
|
Definition
subcutaneous nodules (firm non tender)
chronic joint destruction (SPARING LUMBAR SPINE) in RF+ patients
little joint destruction in RF- patients |
|
|
Term
| when does pauciarticular JIA show up |
|
Definition
|
|
Term
| wat are some signs of pauciarticular JIA (7) |
|
Definition
iridocylitis
irregular pupil
cellular exudate in anterior chamber
sunechiae
keratopathy
cararacts
glaucoma |
|
|
Term
| if someone gets pauiarticular JIA after 8 yo what will their symptoms be (2) |
|
Definition
symptoms in hips, ankles and feet
progresses to lumbar and sacrum |
|
|
Term
|
Definition
| Ca deposits in bowmans layer |
|
|
Term
| what does sunechiae cause (2) |
|
Definition
| irregular pupil and keratopathy |
|
|
Term
| if someone has fever what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has rheumatoid rash what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has rheumatoid nodules what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has hepatosplenomeagly what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has lymphadenopathy what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has chronic uveitis what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has pericarditis what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has pleuritis what type of JIA are you thinking of |
|
Definition
|
|
Term
| if someone has abdominal pain what type of JIA are you thinking of |
|
Definition
|
|
Term
| what are the causes of septic arthritis based on age group |
|
Definition
<4: influenza
teens: gonococcus (gonorrhea)
any age: stephlococus |
|
|
Term
| what are the joint signs of septic arthritis (3) |
|
Definition
swollen, hot
very painful
more red |
|
|
Term
| what are the extra articular signs of septic arthritis (3) |
|
Definition
high fever
look toxic
sepsis |
|
|
Term
| what are three abnormal lab findings in septic arthritis |
|
Definition
puss in joint fluid
positive gram stain
high WBC |
|
|
Term
| when does lyme diseases show up, how does it present over time |
|
Definition
|
|
Term
| what are signs of lyme disease (5) |
|
Definition
| migratory arthritis, flu like, reythema margins rash, neurologic, cardiac |
|
|
Term
| what are two abnormal lab findings in lyme disease |
|
Definition
borrelia burgdori feri antibodies
lyme titer positive |
|
|
Term
| what is the cause of osteomyelitis |
|
Definition
|
|
Term
| what are 4 signs of osteomyelities |
|
Definition
| bone infection, fever, sepsis, bone pain |
|
|
Term
| how can you diagnose osteomyelitis |
|
Definition
| infectous joint and bone will highlight on bone scan |
|
|
Term
|
Definition
| older children and adults |
|
|
Term
| what are symptoms of viral arthritis |
|
Definition
specific to the virus
transient arthritis |
|
|
Term
| what are 3 abnormal labs of viral arhtritis |
|
Definition
viral culture positive
antibody titers positive
transient WBC a teeny bit high
no puss |
|
|
Term
| who gets growing pain (2) |
|
Definition
more in boys
occur from 2-8 yo |
|
|
Term
| why does growing pain occur at night |
|
Definition
| in day muscle splints the joint and growing ends dont rub |
|
|
Term
|
Definition
kids 3 yo +
not usually in us |
|
|
Term
| what are the arthritis signs of rheumatic fever |
|
Definition
| transient migrathroy arthritis |
|
|
Term
| what are the non-arthritic signs of rheumatic feer (5) |
|
Definition
| fever, cardiac disease, chorea, rash, nodules |
|
|
Term
| how is rheumatic fever diagnosed |
|
Definition
| need two major or one major and two minor symptoms + proven strep in past 1-3 weeks |
|
|
Term
| how can you proove someone had strep in the past 1-3 weeks (3) |
|
Definition
| positive strep screen, culture, or strep antibody test |
|
|
Term
| what are the major jones criteria (5) |
|
Definition
| carditis, rash, nodles, arthritis, abnormal body movements (corea) |
|
|
Term
| what are the minor jones criteria (2) |
|
Definition
| EKG changes: prolonged PR interval |
|
|
Term
| what are 2 abnormal lavs in rheumatic fever |
|
Definition
propr strep infection evidence
ECHO/EEG evidence of carditis |
|
|
Term
| what causes rheumatic fever |
|
Definition
| group A B-hemolytic strep |
|
|
Term
| what is the treatment for rheumatic fever (2) |
|
Definition
antiinflammatory
group a strep prophylaxis to prevent reoccurrance |
|
|
Term
| what are the three areas of involvement in dermatomyositis (3) |
|
Definition
|
|
Term
| when do kids get dermatomyocitis |
|
Definition
|
|
Term
| what is the CC in dermitomyocitis (2) |
|
Definition
| hard time getting dressed, tired when doing hair |
|
|
Term
| what are the two most important symptoms of dermatomyocitis |
|
Definition
Ca in subcutaneous and tendon tissue
rash that involves nasolabial folds |
|
|
Term
| what are the symptoms of dermatomyocitis (9) |
|
Definition
swollen inflammed tissue without puss
lots of Ca in subcutaneous and tendons
hyperpigmentation
fatigue
symmetric proximal muscle weakness
tendern swollen muscles with atrophy
gait abnormalities
symmetrical erythematous and atrophy
rash
guttron patches |
|
|
Term
| where does the symmetric erythematous occur in dermatomyocitis (6) |
|
Definition
| knees, elbows, PIP, MCP, violaceous, discoloration on eyelid |
|
|
Term
| what does the rash in dermatomyocitis look like (2) |
|
Definition
involves nasolabial folds
scaley red |
|
|
Term
| what are guttron patches (2), who gets them |
|
Definition
red, scaly patches on knees, wlbows, knucles
skin begins to look like an old person
dermatomyocitis |
|
|
Term
| what anormal labs will someone with dermatomyocitis have (8) |
|
Definition
abnormal EMG
abnormal muscle biopsu
increased creatnine kinase
SGOT
Aldose
increased ESR
positive antinuclear antibody
T2 MRI shows inflammatio |
|
|
Term
| what is the treatment for dermatomyocitis (3) |
|
Definition
| steroids, IVIG, methotrexate (if those fail) |
|
|
Term
|
Definition
| pin point bleeding under skin, wont blanch |
|
|
Term
|
Definition
| more bleeding than patechi |
|
|
Term
|
Definition
| lots of bleeding under the skin (bruise) |
|
|
Term
| when does henoch - schonelin purpura occur |
|
Definition
| mostly under 10 yo, average age 5 |
|
|
Term
| what causes or triggers henoch-schonelin purpura |
|
Definition
| viral infection (especially URI) |
|
|
Term
| what is the prognosis of henoch-schonelin purpura |
|
Definition
|
|
Term
| what is the most important sign of henoch-schonelin purpura |
|
Definition
| non-thrombocytopenic purpura from the waist down with no ukceration or vesicles (could be on face or extremities) |
|
|
Term
| what are other symptoms of henoch-schonelin purpura (14) |
|
Definition
subcutaneous non-pitting edema on hands and feet
periarticular swelling without warmpth or edema
arthritis
cardiopulmonary disease
abdominal pain, pancreatitis
renal involvement
fever
malaise
painfuls crotal swelling
cerebral vasculitis
nose bleeds
seizures
small vessel vasculitis |
|
|
Term
| what are the renal symptoms of henoch-schonelin purpura (4) |
|
Definition
| hematuria, proteinuria, nephrotic syndrome (occasionally), ESRD |
|
|
Term
| what is the treatment for henoch-schonelin purpura (2) |
|
Definition
wait 4 weeks for it to go away
steroids are not recommended |
|
|
Term
| who gets kawasaki syndrome |
|
Definition
|
|
Term
| what is the cause of kawasaki syndrome |
|
Definition
|
|
Term
| what do you need to diagnose kawasaki syndrome |
|
Definition
| fever for 5+days + 4 of the other symptoms |
|
|
Term
| what are the symptoms of kawasaki syndrome (5) |
|
Definition
bilateral conjunctival infection
red mucous membranes in upper respiratory
infected or dry lips
extremity changes: peripherial edema, erythemia, desquamation, peringual desquamation
polymorphic nonvesicular rash: mostly on trunk, morbiliform rash, swollen erythematous
cervical lymphademopathy |
|
|
Term
| what symptoms will occur in kawasaki syndrome in the acute stage 1-11d (9) |
|
Definition
fever, iritability, conjunctivits, oropharyngeal edema, rash, LAP, distal extremity erythema, edema
non exudative nonulcerative bulbar conjunctivitis |
|
|
Term
| what symptoms will occur in kawasaki syndrome in the subacute stage 11-21d (8) |
|
Definition
peeling of hands and feet
thrombocytosis
coronary artery aneurysm
fever
rash
exaggerated leukocytosis
ESR
coronary artery disease |
|
|
Term
| what usually causes death in kawasaki syndrome |
|
Definition
|
|
Term
| what is the prognosis of kawasaki synfrom |
|
Definition
good if no cardiac involvement
12% die with cardiac involvement |
|
|
Term
| what is the treatment for kawasaki synfrome (2) |
|
Definition
IVIG
slicylates: high dose at first, low dose for antiplatelet effects |
|
|
Term
| what is the cause of SLE (2) |
|
Definition
| immune disorder, drug exposure |
|
|
Term
| what abnormal labs will someone with SLE have |
|
Definition
| antinuclear antibodies to anti dsDNA, anti La, anti Ro, anti smooth muscle (RNP) |
|
|
Term
| what are the most important symptoms in SLE (3) |
|
Definition
rash that spares nasolabial folds
mucosal ulceration of the lips and in mouth from vasculitis
scaring alopecia (hair loss) |
|
|
Term
| what disease is associated with raynaud phenomenon |
|
Definition
|
|
Term
| what disease is associated with pleural disease |
|
Definition
|
|
Term
| what is the treatment of SLE (3) |
|
Definition
prednisone
immune supression
anticoagulants |
|
|
Term
| why would someone with SLE get anticoagulants |
|
Definition
| if they have cardiolipin antibodies they are at risk of stroke |
|
|
