Child With Joint Pain
Pain Amplification Syndromes
CTD
Vasculitis
Kawasaki Disease
100

What is the number 1 differential in a child with an erythematous joint?

Septic Arthritis. Also includes rheumatic fever and neoplasia. Red joints are very rare in JIA and other rheumatic conditions. 

100

Name two of the three childhood pain syndromes.

Growing pains, Fibromyalgia, and CRPS

100

What is the most common CTD in childhood. 

SLE:

- 20% of SLE patients present prior to age 18. Usually after the age of 10 and rarely before age 5. 

- Gender ratio is 2:1 (girls:boys)

100

Name the most common vasculitis and cause of acquired heart disease in children. 

Kawasaki Disease

100

True or False; Most children with KD are >5yo

False: 75% of cases occur in children <5yo

200

Which condition is the most common cause of chronic monoarthritis in children (especially girls <5 years)

JIA

200

How long do symptoms need to be present to diagnose a child with fibromyalgia?

>3 months

200

Adult onset SLE vs childhood SLE is similar except in what key way?

Childhood onset SLE is associated with more severe disease, more nephritis, and worse prognosis. 

200

What is the most common cause of small-vessel vasculitis in children

HSP, IgA Vasculitis

200

Name the number one diagnostic criteria needed for KD. (Bonus if you can list the others)

Fever (must be present) and lasts 1-3 wks followed by four of the five:

1. Conjunctivitis (>90%)

2. Oral changes (90%) - strawberry tongue among other changes

3. Cervical lymphadenopathy (20-70%) - least common finding

4. Rash (70-90%) usually diffuse maculopapular eruption

5. Extremity changes (60-85%) - erythema and/or desquamation of palms/soles

300

Nighttime pain and/or awakening with pain are red flags for what two types of conditions (hint: one is serious the other is not). 

Neoplasm and growing pains

300

Which of the pain syndromes is more likely to occur in younger children (age 4-12)?

Growing pains. Fibro is in adolescence and CRPS is starts in late childhood. 

300

Which is more common in children: Linear scleroderma or diffuse scleroderma

Linear scleroderma is 3x more likely than diffuse. Localized scleroderma is often called Morphea. 

300

Name 3 other causes of vasculitis that can be seen in children.

2/2 systemic CTD, ANCA, PAN, primary CNS, Takayasu. Basically, any vasculitis in adults can be seen in children. 

300

What is the initial treatment for acute KD

IVIG and ASA

400

Name the condition that would cause pain over the tibial tubercle exacerbated by exercise.

Osgood-Schlatter

400

Which of the pain syndromes is most likely to show abnormalities on bone scan and what would that abnormality be?

CRPS: osteoporosis

400

How is Juvenile DM different from adult DM or polymyositis? Name two ways.

DM in children is considered a generalized vasculitis

Polymyositis is exceedingly rare in childhood

Malignancy is rarely associated with JDM

400

List the triad of signs and symptoms associated with HSP. (Bonus if you can name the most common trigger)

Purpura

Colicky abdominal pain

Arthritis

Trigger - 50% have a preceding URI

Not part of the triad, but renal disease presents in 40-50% of cases in the first two months of onset.

400
What percentage of patients with untreated Kawasaki disease develop coronary aneurysms?

25%

500

What neoplasms are most likely to have MSK complaints upon presentation? Name 2 of the 4 most common.

Acute leukemia - especially ALL

Neuroblastoma

Ewing Sarcoma - mono-articular

Lymphoma

500

Name two differences in CRPS between adults and children.

1. Less likely to have trauma as a precipitating cause compared with adults

2. Leg is most often involved, skin temperature is cooler, and fewer neuro symptoms in kids

3. Psychologic symptoms are more common

4. Kids have better outcomes and response to PT/OT

500

When linear scleroderma occurs on the face/forehead/scalp (en coup de sabre) it can lead to progressive hemifacial atrophy also known as this syndrome

Parry-Romberg Syndrome

- can also see ANA positive (50%), RF positive (10-25%), hypergammaglobulinemia, arthritis, seizures, and uveitis.

500

What enzyme deficiency has been associated with some cases of childhood onset PAN?

adenosine deaminase 2 deficiency (DADA2)

500

What season in North America are KD outbreaks most common?

Winter/Early Spring

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