Paediatric Rheumatology Notes

Paediatric Rheumatology

  • Paediatric Rheumatology focuses on diagnosing and managing inflammatory conditions.

Juvenile Idiopathic Arthritis (JIA)

  • Juvenile: Onset before the 16th birthday.
  • Idiopathic: No identified underlying cause.
  • Arthritis: Persistent joint swelling (or painful restriction of movement) lasting at least 6 weeks.
  • Diagnosis relies on history and examination, as there are no pathognomonic features.

Types of JIA

  • Oligoarticular: ≤4 joints
    • Persistent
    • Extended
    • Commonly affects the knee (56%) and ankle (20%).
    • Associated with chronic anterior uveitis.
  • Polyarticular: >4 joints
    • RhF negative
    • RhF positive
  • Psoriatic Arthritis: Arthritis with psoriasis or arthritis plus two of the following:
  • Enthesitis-related Arthritis
  • Systemic arthritis

Family Misfortunes (Presentations of Arthritis in Children)

  1. Swelling - persistent
  2. Joint stiffness (morning)
  3. Loss of range of movement
  4. Pain
  5. Joint deformity
  6. Warmth
  7. Colour change

pGALS (paediatric Gait, Arms, Legs, Spine) Screen

  • Musculoskeletal screening examination for school-age children.
  • Quick and easy to perform.
  • Indications: limp, MSK pain, delay/regression of motor milestones, inflammatory symptoms.
  • Gait: Observe walking and turning, tiptoe, and heels.
  • Arms: Spread fingers wide, finger tuck, thumb to little fingertip, squeeze metacarpal heads, prayer sign, hands to ceiling and look up, hands behind heads.
  • Legs: Patella tap, flex hip to 90°, internal rotation of hip, heel to bum.
  • Spine: Tilt head to side, 3-finger jaw opening, observe for scoliosis on forward flexion, lumbar flexion, reach for the sky.