Notes: Pathergy test is positive where prick of skin with needle causes pustule in 48 hours.
Question: What fits these findings?
Dermatomyositis
Category: generalpediatrics-Rheumatology
Findings: Grottons papules, heliotropic and violaceous malar rash, proximal weakness, telangiectasias near nails, elevated CK
Notes: Diagnose with muscle biopsy and MRI.
Question: What fits these findings?
Drug-induced Lupus
Category: generalpediatrics-Rheumatology
Findings: joint pain and fatigue induced by anti-seizure medications, lithium, quinidine, statins, hydralazine, sulfa drugs, procainamide
Question: What fits these findings?
Fibromyalgia
Category: generalpediatrics-Rheumatology
Findings: pain in multiple areas, sleep disturbance, fatigue, morning stiffness that resolves with activity, treated with cognitive behavioral therapy and medications such as amitriptyline or SSRIs
Question: What fits these findings?
Granulomatosis With Polyangiitis
Category: generalpediatrics-Rheumatology
Findings: positive c-ANCA, elevated creatinine, nodules in lungs on CXR, fever, weight loss, cough, epistaxis
Notes: Previously known as Wegener's.
Immunoglobulin A Vasculitis
Category: generalpediatrics-Rheumatology
Findings: purplish rash on legs and buttocks, abdominal pain, microscopic or gross hematuria, elevated WBCs, proteinuria, normal complement levels
Notes: Treat with NSAIDs for joint pain if no kidney issues seen. Steroids and chemotherapy drugs may be needed for severe cases. Previously known as Henoch-Schonlein purpura.
Question: What fits these findings?
Juvenile Ankylosing Spondylitis
Category: generalpediatrics-Rheumatology
Findings: pain in sacroiliac joint, pain worsened by rest and at night and improved with activity, morning stiffness, normal labs, uveitis, fusion of spine
Neonatal Lupus
Category: generalpediatrics-Rheumatology
Findings: petechiae, rash, thrombocytopenia, elevated LFTs, third degree AV heart block, bradycardia, positive maternal anti-Ro or anti-La
Oligoarticular Juvenile Idiopathic Arthritis
Category: generalpediatrics-Rheumatology
Findings: four or fewer joints involved, morning stiffness, positive ANA, common in younger girls, chronic uveitis
Question: What fits these findings?
Polyarticular Juvenile Idiopathic Arthritis
Category: generalpediatrics-Rheumatology
Findings: more than four joints involved, potentially positive ANA and RF, pain in cervical spine, hip pain, fatigue, common in younger girls
Question: What fits these findings?
Psoriatic Juvenile Idiopathic Arthritis
Category: generalpediatrics-Rheumatology
Findings: wrist and hand arthritis, DIP joint arthritis, dactylitis, enthesitis, nail-pitting, uveitis, psoriasis, elevated inflammatory markers, positive ANA
Notes: Treat initially with NSAIDs for mild cases. DMARDS may be required for severe cases.
Question: What fits these findings?
Reactive Arthritis
Category: generalpediatrics-Rheumatology
Findings: oral ulcers, fever, arthritis in knee or hip, conjunctivitis, urethritis, recent gastrointestinal infection
Notes: Can't see, can't pee, can't climb a tree.
Sarcoidosis
Category: generalpediatrics-Rheumatology
Findings: chronic cough, hilar adenopathy, weight loss, fatigue, noncaseating granulomas on lung biopsy, swelling of ankles, treated with systemic steroids
Question: What fits these findings?
Sjogren Syndrome
Category: generalpediatrics-Rheumatology
Findings: dry mouth and eyes, recurrent parotitis, fatigue, confirmed with biopsy of salivary gland to check for lymphocytic infiltration, positive RF and ANA
Question: What fits these findings?
Systemic Juvenile Idiopathic Arthritis
Category: generalpediatrics-Rheumatology
Findings: evanescent salmon-colored rash, very high leukocytosis, hepatosplenomegaly, high fevers, lymphadenopathy, pericarditis, pleurisy, negative ANA
Notes: May lead to macrophage activation syndrome with elevated transaminases, thrombocytopenia, very elevated ferritin, elevated D-dimer
Question: What fits these findings?
Systemic Lupus Erythematosus (SLE)
Category: generalpediatrics-Rheumatology
Findings: malar rash, arthralgias, discoid lesions, oral or nasal ulcers, positive ANA, anti-DNA and anti-Smith antibodies, anemia, thrombocytopenia
Notes: Treat with NSAIDS initially for mild cases. For severe cases, steroids, methotrexate, or hydroxychloroquine may be required.