Pediatric Rheumatology
Domain focus
Pediatric Rheumatology tests juvenile idiopathic arthritis, Kawasaki disease, systemic lupus erythematosus, Henoch–Schönlein purpura and periodic fever syndromes.
Core rules
- JIA: arthritis lasting over 6 weeks in one or more joints, with morning stiffness; exclude infection and malignancy.
- All children with JIA need regular slit-lamp screening for uveitis, especially pauciarticular disease.
- Kawasaki disease: fever for at least 5 days plus four of five features-conjunctivitis, mucositis, rash, extremity changes and cervical lymphadenopathy. Give IVIG and aspirin, and perform echocardiography.
- HSP: palpable purpura on dependent areas, abdominal pain, arthritis and renal involvement; check urine and blood pressure.
- SLE: multisystem disease with ANA, low complement and cytopenias.
Worked example
A 6-year-old has fever for 7 days, bilateral conjunctivitis, cracked lips, a polymorphous rash and cervical lymphadenopathy. This is Kawasaki disease. Admit, give IVIG 2 g/kg and aspirin, and arrange echocardiography. Treat promptly because coronary artery aneurysms are time-dependent.
Traps
Missing incomplete Kawasaki in an infant with prolonged fever; not screening for uveitis in JIA; treating HSP with steroids routinely; stopping immunosuppression abruptly.