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Chapter-16 Rheumatology

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

Author
1. Singh Surjit
2. Sharma Dhrubajyoti
ISBN
9789352501977
DOI
10.5005/jp/books/12810_17
Edition
1/e
Publishing Year
2016
Pages
10
Author Affiliations
1. All India Institute of Medical Sciences, New Delhi, India, Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India, Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research, Chandigarh, Advanced Pediatrics Center, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Immunology Unit, Advanced Pediatrics Center, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute, of Medical Education and Research, Chandigarh, India, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; Indian Council of Medical Research (ICMR) Centre for Advanced Research, Primary Immunodeficiency Diseases, Chandigarh, India, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Cha
2. Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
Chapter keywords
juvenile rheumatoid arthritis, Kawasaki disease, systemic lupus erythematosus, rheumatic fever, Arthralgia, nonsteroidal anti-inflammatory drugs, coronary artery abnormalities, rheumatic heart disease, hematological systems, Acute rheumatic fever, prophylactic penicillin

Abstract

This chapter provides an overview of arthralgia, juvenile rheumatoid arthritis, Kawasaki disease, systemic lupus erythematosus, rheumatic fever and heart disease. Arthralgia is one of the most common rheumatological problems in children. In most cases, it is a benign condition, the common causes being trauma or viral infections. Traumatic pain, growing pains, juvenile idiopathic arthritis, acute rheumatic fever, septic arthritis, osteomyelitis and toxic synovitis are common pediatric conditions which must be considered while evaluating a child with arthralgia. Any child with persistent nocturnal musculoskeletal pain should never be ignored. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease in childhood. Oligoarticular (pauciarticular) arthritis (involvement of ≤4 joints), polyarticular arthritis (involvement of ≥5 joints) and systemic arthritis are important groups of JIA under the International League of Associations for Rheumatology (ILAR) classification. Patients with OA usually respond well to nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular steroids. Rheumatoid factor positive polyarticular JIA usually behaves like rheumatoid arthritis in adults and is associated with erosive disease and a high morbidity. Kawasaki disease (KD) is the most common vasculitis in children. The disease is diagnosed with the help of the established criteria as enunciated by the American Heart Association (AHA). Kawasaki disease is a self-limiting disease. However, if untreated, in 1/4th of cases (25%) it is complicated by development of coronary artery abnormalities (CAA). Treatment with intravenous immunoglobulin (IVIg) brings down this figure to 3–5%. Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. It commonly affects the skin, kidneys, musculoskeletal and hematological systems. Acute rheumatic fever (ARhF) is a common cause of acquired heart disease in children in developing countries. It has now been replaced by Kawasaki disease in children in the developed world. Early diagnosis of ARhF and institution of prophylactic penicillin is a must for prevention of rheumatic heart disease (RHD).

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