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Pediatric Arthritis Syndromes,[object Object],Dr Abdullah Aburiziza,[object Object],MD, FAAP, FAAAAI,[object Object],Assistant  professor ,[object Object],Pediatric Allergy/Clinical Immunology,[object Object],Um AlQura University,[object Object],Makkah,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Outlines,[object Object],Approach to Arthritis,[object Object],Juvenile Rheumatoid (Idiopathic) Arthritis,[object Object],Kawasaki Disease,[object Object],Henoch-Schönlein Purpura,[object Object],Juvenile Dermatomyositis,[object Object],SLE,[object Object],Growing pain ,[object Object],Hypermobility Syndrome,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Approach to Arthritis,[object Object],Ask about the following:,[object Object],-Presenting Complain ( reason for admission),[object Object],-HPI,[object Object],Joints Symptoms, problem joints , morning stiffness, pain, tenderness, swelling, limitation of movement, splints, orthoses, trauma…,[object Object],General health, fever, pallor, weight loss,[object Object],Skin rash, color, distribution, size site itchiness fading, bleeding, secretion..ect,[object Object],GI, IBD,[object Object]
Eyes, redness, secretions,  disturbed vision, cataract,[object Object],CNS, seizure, personality changes, drowsiness, headache..,[object Object],Drugs side effects, steroid, poor height gain, weight gain …,[object Object],Level of function, walking, eating,  writing, dressing, wheelchair, walker…,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
PMH,[object Object],  Initial diagnosis, when, presentation, investigation, trigger, hospitalizations, sequence of joints involvement, complications( disease or medications),[object Object],Management:  physiotherapy, sports, drugs, side effect, diet,[object Object],Social History: Child, Parents, Sibling, Social support, Financial,[object Object],Family History, Arthritis, IBD, psoriasis, uveitis, thyroid disease…,[object Object]
At the completion of your history, you should have a clear impression of the patient’s:,[object Object],Current function,[object Object],Current and past treatment modalities,[object Object],Cooping with the disease,[object Object]
Examination,[object Object],Vitals,[object Object],Anthropometric measurement,[object Object],Rash,[object Object],Joint Examination, # of joints,[object Object],[object Object]
 Palpation. temperature, effusion, tenderness
Range of movement, exact with measurement of limitationDr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Investigations,[object Object],CBC,[object Object],XRAY,[object Object],ESR, CRP.,[object Object],ASO titer,[object Object],ANA,[object Object],Anti DNA,[object Object],RF,[object Object],Echo,[object Object],HLA B27,[object Object],Biopsy,[object Object],…………,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Juvenile Rheumatoid (Idiopathic) Arthritis,[object Object],Autoimmune disease of unknown etiology.,[object Object],Inflammation of the joint synovium. ,[object Object],The disease has two peaks, one at ages of 1 to 3 years and another peak at ages 8 to 12 years. ,[object Object],Girls are affected more commonly than boys,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
The diagnosis of JRA is established by the presence of arthritis, the duration of the disease for at least 6 weeks, and the exclusion of other possible diagnoses.,[object Object],Children must be younger than 16 years old at time of onset of disease; the diagnosis of JRA does not change when the child becomes an adult.,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
CLINICAL PRESENTATION,[object Object],Table 89-1. Features of Juvenile Rheumatoid Arthritis Subgroups,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Pauciarticular Juvenile Rheumatoid Arthritis,[object Object],Fewer than five joints within the first 6 months from diagnosis.,[object Object],This is the most common form of JRA, 50% of cases.,[object Object],Peak at ages 1 to 3 years and another broader peak at ages 8 to 12 years.,[object Object],Medium-sized to large joints, (knee) ,[object Object],NO evidence of systemic inflammation (fever, weight loss, or failure to thrive) or any laboratory evidence of systemic inflammation (elevated WBC count or ESR).	,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Polyarticular Juvenile Rheumatoid Arthritis,[object Object],Five or more joints within the first 6 months of diagnosis,[object Object],40% of cases.,[object Object],can affect any joint, but typically involves the small joints of the hands, feet, ankles, wrists, and knees.,[object Object],Can present with evidence of systemic inflammation, including malaise, low-grade fever, growth retardation, anemia of chronic disease, and elevated markers of inflammation.,[object Object],Polyarticular JRA can present at any age, although there is a peak in early childhood( RF –ve). ,[object Object],There is a second peak in adolescence( RF +ve),[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Systemic-Onset Juvenile Rheumatoid Arthritis,[object Object],Typical recurring spiking fever, usually once or twice a day, which can occur for several weeks to months.,[object Object],Rash, typically morbilliform and salmon colored, evanescent and occur only at times of high fever.,[object Object],Serositis, such as pleuritis and pericarditis, occurs in half of children.,[object Object],Hepatosplenomegaly occurring in 70% of children.,[object Object],Significant constitutional symptoms, including malaise and failure to thrive.,[object Object],Elevated ESR, CRP, WBC count, and platelet counts and anemia.,[object Object],Arthritis of JRA follows the systemic inflammation by 6 weeks to 6 months.,[object Object],The arthritis is typically polyarticular ,extensive and resistant to treatment, with risk for long-term disability.	,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Connective Tissue Diseases,[object Object],[object Object]
Systemic lupus erythematosus
Juvenile dermatomyositis
Scleroderma with arthritis Seronegative Spondyloarthropathies,[object Object],[object Object]
Juvenile ankylosing spondylitis
Psoriatic arthritis
Reiter syndrome
Inflammatory bowel disease Infectious Arthritis,[object Object],[object Object]
Lyme disease Reactive Arthritis,[object Object],[object Object]
Rheumatic fever
Toxic synovitis
Henoch-Schönlein purpura
Orthopedic Disorders
Traumatic arthritis
Legg-Calvé-Perthes disease
Slipped capital femoral epiphysis
Osteochondritis dissecans
Chondromalacia patellae
Musculoskeletal Pain Syndromes
Growing pains
Hypermobility syndromes
Myofascial pain syndromes/fibromyalgia
Reflex sympathetic dystrophy
Hematologic/Oncologic Disorders
Leukemia, Lymphoma, Sickle cell disease, Thalassemia, Malignant and benign tumors of bone, cartilage, or synovium
Metastatic bone disease
Miscellaneous
Rickets/metabolic bone disease
Lysosomal storage diseases
Heritable disorders of collagenDr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Investigations,[object Object],CBC-Diff,[object Object],ESR,[object Object],CRP,[object Object],ASO,[object Object],ANA, Anti-DNA,RF. ,[object Object],X-Ray,[object Object],Arthrocenthesis,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
TREATMENT,[object Object],NSAIDs,[object Object],Systemic Steroid,[object Object],Intraarticular Steroid injection,[object Object],Second-line medications, such as hydroxychloroquine , sulfasalazine, Methotrexate.,[object Object],Physiotherapy and occupational therapy,[object Object],Ophthalmology referral.,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Complications,[object Object],Loss of function of an involved joint secondary to joint contractures or bony fusion or loss of joint space. ,[object Object],Uveitis, which if left untreated can lead to serious visual loss or blindness.,[object Object],Systemic-onset disease, a positive RF, poor response to therapy, and the presence of erosions on x-ray all predict a poorer prognosis.,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]
Kawasaki Disease,[object Object],KD is a vasculitis of unknown etiology that is characterized by multisystem involvement and inflammation of small to medium-sized arteries with resulting aneurysm formation.,[object Object],KD most commonly occurs in children younger than age 5, with a peak between ages 2 and 3 years, and is rare in children older than age 7.,[object Object],Dr Abdullah Aburiziza,MD,  FAAP, FAAAAI, Assistant Professor, Allergy/Immunology,[object Object]

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Pediatric Arthritis Syndromes

Notes de l'éditeur

  1. he common underlying manifestation of this group of illnesses is the presence of chronic synovitis, or inflammation of the joint synovium. The synovium becomes thickened and hypervascular with infiltration by lymphocytes, which also can be found in the synovial fluid along with inflammatory cytokines. The inflammation leads to the production and release of tissue proteases and collagenases, which if left untreated can lead to tissue destruction, particularly of the articular cartilage and eventually the underlying bony structures.
  2. Cervical lymphadenopathy is found in 70% of children and should be greater than 1.5 cm in diameter for the purposes of diagnosis. , which can vary in appearance, occurs in 80% of children with KD and may be particularly accentuated in the inguinal area and on the chest.
  3. which usually appear in the subacute and convalescent phases, and pose the highest risk of sudden death. Risk factors for development of coronary artery aneurysms include prolonged fever, prolonged elevation of inflammatory parameters such as the ESR, age younger than 1 year, and male gender. Body_ID: P088005 page 430 page 431 Body_ID: P0431