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8 terms

Rheum diseases

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how do the different histories present of RA, OA?
Pain during rest & on initiating activity suggests - inflammatory
Pain worsened by movement and relieved by rest -suggests mechanical disorders
Gradual onset of pain - typical of RA or noninfectious arthritis
PE - active vs. passive (referred) movements; pain tenderness; heat and erythema
symptoms of septic arthritis?
Infection evolves over hours or days
Develops moderate to severe joint pain, warmth, tenderness, effusion, redness ±
`In synovial or periarticular tissues
Systemic symptoms may be absent
how might a septic arthritis appear in kids?
Limited spontaneous movement of a limb (pseudoparalysis)
Irritability
Feeding disturbances
High, low-grade, or no fever
how is spetic arthritis dx?
Arthrocentesis
Synovial fluid examination - cornerstone of diagnosis
Culture
Imaging - gas (E. coli; anaerobes)
Blood studies - Blood cultures, CBC, and ESR (or C-reactive protein etc)
how is septic arthritis tx?
Parenteral antibiotics -continued until clinical improvement is clear (usually 2 wk)
Ceftriaxone; ciprofloxacin; nafcillin; vancomycin; doxycycline; clindamycin etc.
Oral antibiotics - given at high doses for another 2 to 6 wk according to the clinical response
Staphylococcal infections - 6wk plus; vancomycin
Acute non-gonococcal bacterial arthritis
Aspiration - intra-articular pus at least once/day, or tidal irrigation lavage, arthroscopic lavage, or arthrotomy for debridement
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signs and symptoms of Juvinile RA(JRA)
Joint stiffness
Swelling
Effusion
Pain
Tenderness
May interfere with growth and development
Micrognathia - due to early closure of mandibular epiphyses
Iridocyclitis
Conjunctival injection, pain, and photophobia
Or asymptomatic
Scarring and glaucoma with band keratopathy can result
Tx of JRA?
NSAIDs and disease-modifying antirheumatic drugs(methotrexate,hydroxychloroquinw,etanercept)
steroids in severe systemic dz only
supportive--PT,exrcises,splints,prevent flexion contractures
common presentations of still's dz?
Commonly
High fever, rash, splenomegaly, generalized adenopathy, and serositis with pericarditis or pleuritis are
May precede arthritis
Fever
Often highest in the afternoon or evening and may persist for up to 2 wk
Transient rash - often appears with the fever
Or may be diffuse and migratory, with urticarial or macular lesions