Child With Joint Pain
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.
Name two of the three childhood pain syndromes.
Growing pains, Fibromyalgia, and CRPS
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)
Name the most common vasculitis and cause of acquired heart disease in children.
Kawasaki Disease
True or False; Most children with KD are >5yo
False: 75% of cases occur in children <5yo
Which condition is the most common cause of chronic monoarthritis in children (especially girls <5 years)
JIA
How long do symptoms need to be present to diagnose a child with fibromyalgia?
>3 months
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.
What is the most common cause of small-vessel vasculitis in children
HSP, IgA Vasculitis
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
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
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.
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.
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.
What is the initial treatment for acute KD
IVIG and ASA
Name the condition that would cause pain over the tibial tubercle exacerbated by exercise.
Osgood-Schlatter
Which of the pain syndromes is most likely to show abnormalities on bone scan and what would that abnormality be?
CRPS: osteoporosis
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
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.
25%
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
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
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.
What enzyme deficiency has been associated with some cases of childhood onset PAN?
adenosine deaminase 2 deficiency (DADA2)
What season in North America are KD outbreaks most common?
Winter/Early Spring