Pediatric Rheumatology

what is the MC childhood rheumatic disease?

-juvenile idiopathic arthritis

what is juvenile idiopathic arthritis?

-inflammatory immune-mediated arthropathies found in patients < 16yo characterized by chronic > 6 week inflammation of synovium

how does juvenile idiopathic arthritis present?

-pain

-edema

-warmth

-morning stiffness

-decreased ROM

how does systemic juvenile idiopathic arthritis present?

-intermittent high fevers

• unresponsive to NSAIDs

-transient rash

-arthritis

what is the MC type of juvenile idiopathic arthritis?

-oligoarticular

how does oligoarticular juvenile idiopathic arthritis present?

-< 5 joints affected

-no systemic Sx

-chronic uveitis if ANA (+)

oligoarticular juvenile idiopathic arthritis is MC in what patient demographic?

-females < 4yo

how does polyarticular juvenile idiopathic arthritis present?

-5+ joints affected

-symmetric arthritis

what is the recommended laboratory workup for suspected juvenile idiopathic arthritis?

-ESR/CRP

-CBC

-ANA

-Rh factor

-anti-CCP antibody

what are the expected lab findings of juvenile idiopathic arthritis?

-elevated ESR/CRP

-leukocytosis

-(+/-) (+) ANA, Rh factor, anti-CCP antibody

what imaging is often used for juvenile idiopathic arthritis?

-x-ray

-US

-MRI

what is the expected synovial fluid WBC count with joint trauma?

< 2000

what is the expected synovial fluid WBC count with reactive arthritis?

-3000-10,000

what is the expected synovial fluid WBC count with juvenile idiopathic arthritis?

-5000-60,000

what is the expected synovial fluid WBC count with septic arthritis?

> 60,000

what is the Tx for juvenile idiopathic arthritis?

-supportive

• rheumatology referral

• PT/OT

• mild: NSAIDs

-pharm

• mod-severe: NSAIDs + biologic (anakinra) or steroids

• (+/-) DMARD (methotrexate)