PEDIATRICS
■ Hepatosplenomegaly
■ Lymphadenopathy
■ Pleuritis or pericarditis
■ Rarely: Myocarditis, hepatitis, DIC
DIFFERENTIAL
■ Infection: Septic arthritis, osteomyelitis, Lyme disease
■ Malignancy: Either systemic (such as leukemia) or bone
■ Trauma
■ Orthopedic conditions: Slipped capital femoral epiphysis (SCFE),
Osgood-Schlatter disease, Legg-Calvé-Perthe’s disease
■ Avascular necrosis
DIAGNOSIS
Diagnosis of JRA requires eliminating alternative etiologies. Serum or syn-
ovial fluid analysis may support the diagnosis of JRA, but no studies are
pathognomonic.
■ Anemia
■ Leukocytosis
■ Thrombocytosis
■ Elevated ESR, c-reactive protein (CRP)
■ Synovial fluid: WBC 10,000–100,000/mm^3 , low glucose
TREATMENT
■ Treatment options are limited.
■ NSAIDs are most often prescribed.
■ Rest, physical therapy, and occupational therapy may also be important.
■ For patients with pauciarticular disease, regular slitlamp examinations are
important to detect the onset of iridocyclitis (anterior uveitis) and begin
specific therapy before vision is compromised.
■ Adjunctive therapies, including systemic steroids, hydroxychloroquine,
methotrexate, and oral gold should generally not be prescribed through
the ED without the involvement of a pediatric rheumatologist.
COMPLICATIONS
■ Deformity of limbs and joints in a minority of patients with JRA
■ Growth disturbances of limbs
■ Recurrent arthritis
■ Blindness may develop in patients with iridocyclitis if treatment is not
started promptly.
Henoch-Schönlein Purpura
■ HSP is an acute, systemic vasculitis, primarily affecting venules and
arterioles.
■ Etiology is unknown, but may be due to the host response to an infection
(such as strep pharyngitis, varicella, or mycoplasma).
■ Typically affects children 3–7 years of age, with males affected more fre-
quently than females (2:1)
■ Symptoms typically last 4–6 weeks, with 50% of patients having recurrent
symptoms usually within weeks of the initial diagnosis.
Triad of symptoms for HSP:
Purpura, abdominal pain,
arthritis