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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The imaging description is that of a joint effusion, causes of which include septic arthritis, transient synovitis and juvenile idiopathic arthritis. Juvenile idiopathic arthritis presents in patients less than 16 years old with a duration greater than 6 weeks. Most are seronegative; raised erythrocyte sedimentation rate and anaemia may be present. The knee joint is the most common site for the monoarticular variant. Periostitis is considered typical and is most common in the metacarpal and metatarsal bones. There is often premature closure of the growth plates/accelerated skeletal maturation. Unlike in rheumatoid arthritis, bone changes occur late and there is more ankylosis and widening of the metaphysis.
Muscular dystrophy and arthritis
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
Juvenile idiopathic arthritis is characterized by major changes in the joints, muscle and tissue tightening including inflammation, contractures, and joint damage, all of which can affect mobility, strength, and endurance. Children may come to school with varying degrees of pain and stiffness or miss school entirely (Arthritis Foundation, 2017). Nearly all children with arthritis experience periods when symptoms reduce in severity or disappear, although they may go quickly from being symptom free to experiencing extreme pain and swelling. When the child is symptom free, or even relatively symptom free, the child should be encouraged to participate in most, if not all, developmentally appropriate physical activities. Developmental appropriateness is emphasized because many children with serious and prolonged involvement are smaller and less physically mature than their typically developing chronological age (CA) peers are. Splinting is occasionally the procedure of choice when the purpose is to rest tender joints or prevent or minimize contractures. Typically, removable casts may be used at night or for periods during the day. For example, a wrist splint worn during the day may permit active finger use while protecting the painful and possibly malformed wrist from unnecessary trauma.
Bones, joints, muscles and tendons
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Apart from other joint involvement, there may be generalized wasting and anaemia. Three systemic diseases are associated with rheumatoid joint disease: Still’s disease, a disease in which adults develop arthritis, splenomegaly and lymphadenopathy. A similar condition can occur in children, known as systemic onset juvenile idiopathic arthritis.Reiter’s syndrome, in which there is urethritis, conjunctivitis, skin rashes and arthritis.Systemic lupus erythematosus, a collagen disease in which there is a scaly, red rash on the face, debility and manifestations in all tissues of a small vessel arteritis.Other conditions, which may also present in a similar fashion to rheumatoid arthritis (Revision panel 6.3)
Identifying the response process validity of clinical vignette-type multiple choice questions: An eye-tracking study
Published in Medical Teacher, 2023
Francisco Carlos Specian Junior, Thiago Martins Santos, John Sandars, Eliana Martorano Amaral, Dario Cecilio-Fernandes
Boy, three-year-old, was brought to the Emergency Room with pain in the right lower limb and difficulty in walking for one day. Family history: brother with an upper respiratory tract infection for 10 days. Physical examination: T = 36.8 °C; RR = 16 breaths per minute; HR = 90 beats per minute; Limbs: limitation of internal and external rotation of the right hip; does not perform complete extension of the right lower limb. The most likely diagnosis is:Rheumatic fever.Legg-Calve-Perthes disease.Transient synovitis.Juvenile idiopathic arthritis.
Current and emerging biologics for the treatment of juvenile idiopathic arthritis
Published in Expert Opinion on Biological Therapy, 2020
Rolando Cimaz, Gabriella Maioli, Giulia Calabrese
Biologic therapies for juvenile idiopathic arthritis and other pediatric conditions have revolutionized the outcome of these disorders. Approval of these drugs has followed what had been achieved in adult rheumatology, mainly thanks to regulatory agencies. There is now a plethora of therapies that are directed against variable targets, and the clinician has the choice of several drugs for the same conditions. Research is advancing very fast, and it is likely that in the next future more drugs will be approved. Oral ways of administration are already available for small molecules, and this is certainly an advantage when dealing with young children. The compliance is, in fact, one of the major obstacles for correct long-term treatment. Studies on disease pathogenesis will hopefully shed light on the complexity of these disorders, and the hope is the discovery of new targets, in order to be more and more specific in suppressing inflammatory pathways without harming natural defenses. In the pediatric age, it is it critical to consider the immaturity of the immune system, and the long life expectancy. Reports of neoplastic disorders and infectious risk carry a substantial burden for the families, but current data are relatively reassuring. Finally, pharmacoeconomics considerations will also be very important to deal with, considering the high cost of most of these molecules. Availability of drugs in a large part of the word is limited, and industries should work with governments in order to plan activities which may benefit young patients also in underserved areas.
Overcoming diagnostic and treatment challenges in uveitic glaucoma
Published in Clinical and Experimental Optometry, 2019
Erin R Sherman, Malinda Cafiero‐chin
Juvenile idiopathic arthritis is an autoimmune disease that typically affects children under the age of 16 years. It is the most common cause of uveitis in children.2006 There are seven sub‐types, each with different risks for glaucoma. The lowest risk occurs with systemic juvenile arthritis, classified as stiffness and pain of all joints and paired with intermittent rash, fever, and internal organ involvement. The oligoarticular sub‐type holds the highest risk for uveitis development at about 30 per cent.2008 It affects four or fewer joints, often the knee, and less frequently, the ankle or wrist. Symptoms include joint pain, stiffness, or swelling. It affects males more than females by a five‐to‐one ratio. Polyarticular arthritis involves more than four joints in the first six months of diagnosis. Further sub‐typing of oligoarticular and polyarticular arthritis includes anti‐nuclear antibody testing. Anti‐nuclear antibody positivity increases the risk of ocular complications. Systemic and oligoarticular types are 10 per cent and 75 per cent anti‐nuclear antibody positive, respectively.2008