Swollen Joint in Children – Pediatrics | Lecturio

Swollen Joint in Children – Pediatrics | Lecturio


[Music] in this brief lecture we’re going to discuss the swollen joint in children and in particularly the swollen joint where it is essentially a transient autoimmune condition this would be either reactive arthritis or transient synovitis this is an important lecture because these two entities appear quite commonly in children but they’re basically benign conditions I’m going to go through them and explain the differences between them now so reactive arthritis at one point was also called Reiter’s syndrome is an autoimmune attack on a joint typically after an infection and usually it’s more common in GU or GI infections so the classic GU infection that can result in a reactive arthritis is chlamydia in adolescence with chlamydia they can after the infection starts then later develop an autoimmune attack on their joints from a GI standpoint there are some bugs that are implicated more likely in an autoimmune attack or a a reactive arthritis these include Yersinia and t’rul it Iike Salmonella enteritis Shigella and Campylobacter in other words the bacterial pathogens other than E coli that are most likely to cause this problem there is also group a strep which perhaps we will consider as a different issue group a strep reactive arthritis is a part of rheumatic fever and we’ll discuss rheumatic fever in another lecture ok so reactive arthritis typically is reactive that means first you have the infection you make the antibodies against that bug and those antibodies through freakish occurrence also attack your joints later on down the line so this usually happens 1 to 4 weeks after the first infection it has acute onset and it may be migratory involving multiple joints there’s a classic phrase for chlamydia can’t see P can’t climb a tree what that is basically pointing out is these patients can get eye involvement can’t pee means they’re having the urethritis of chlamydia and can’t climb a tree means their knees are swollen so that’s a classic thing for what we previously called writer syndrome but now we’re just calling reactive arthritis so for reactive arthritis the diagnosis is really usually made clinically if there’s still something there you could test for the causative disease for example certainly with chlamydia a urine chlamydia test is positive and unless that patient has been treated that test will continue to be positive in fact it’ll be positive in a substantial number of cases where they have been treated and they might need to be treated again but in patients who’ve just had say Campylobacter the Campylobacter is long gone usually by the time they’re developing the reactive arthritis so testing isn’t possible so most of the time we don’t bother with testing up to 80% of patients who have reactive arthritis are HLA b27 but knowing someone is HLA b27 probably isn’t particularly beneficial if they were to go on to develops a ankylosing spondylitis we would be testing them anyway so it’s unclear that knowing their HLA type is particularly helpful we do like to rule out other potential causes that are more significant than reactive arthritis for example through history and physical exam we can probably rule out lupus or an infected joint or the other things that are more significant and require more aggressive therapy reactive arthritis is managed typically through containing the inflammation and the good news is these children usually get better reasonably well and have a great prognosis we usually start off with treating with NSAIDs that’s the most important therapeutic air we often we use long-acting NSAIDs like twice a day Naprosyn or even once day meloxicam as a way of controlling their inflammation without having to take medicines every six hours like you would with Pro Fionn the goal is to sustain the inflammation as much as it is to control the pain injected steroids can absolutely be done either systemically or intra-articular Li if this is a very severe reactive arthritis if there were multiple joints involved I might go with the systemic steroids first children with rheumatic fever will go on to penicillin prophylaxis but we’ll discuss that more in the rheumatic fever lecture so let’s switch gears now and talk about a disease which is very similar to reactive arthritis but is distinguishable because it happens during or just immediately after the infection as opposed to one or four weeks later and that is the key point the user member high impact on the test reactive arthritis have one to four weeks after an infection transient synovitis happens either during or just after the infection also the infection is usually in transient synovitis of viral syndrome it’s usually an upper respiratory infection or a URI typically the age of a child who has to having transient synovitis is there between 2 and 12 years of age and typically this will affect one maybe two joints and usually the hips first choice then the knee then something else this is usually mono articular inflammation it’s usually a child showing up with a swollen knee and that’s it and oh yeah they had a cold yesterday the problem is usually mild they may not be able to bear weight but will transiently be sick but then often be better in only one or two days and it may be completely resolved in three to four days because this is such a short-lived phenomenon we usually just treat with NSAIDs we may do a couple days of Naprosyn or ibuprofen as needed remember transient synovitis is transient it’s an inflammation of the joint it’s during the virus and this is incredibly common it’s impossible to pry for a year as a pediatrician without seeing a case so that’s my summary of these two conditions thanks for your attention [Music]

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