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Toronto Notes 2019 Rheumatology Pediatrics P85 Lyme Arthritis
• seeInfectiousDiseases,ID23
• causedbyspirocheteBorreliaburgdorferi
• incidencehighestamong5-10yrolds
• donottreatchildren<8yroldwithdoxycycline(maycausepermanenttoothdiscolouration)
Reactive Arthritis
• seeRheumatology,RH24
• arthritis(typicallytheknee)followsbacterialinfection,especiallywithSalmonella,Shigella,Yersinia,
Campylobacter, Chlamydia, and most commonly Streptococcus (post-streptococcal reactive arthritis)
• typicallyresolvesspontaneously
• mayprogresstochronicillnessorReiter’ssyndrome(urethritis,conjunctivitis)
Septic Arthritis and Osteomyelitis
• MEDICALEMERGENCY
• seeOrthopedics,OR10
Table 42. Microorganisms and Treatment Involved in Septic Arthritis/Osteomyelitis
Age
Neonate
Infant (1-3 mo)
Child Adolescent
GAS = group A Strep; GBS = group B Strep
Systemic Lupus Erythematosus
• seeRheumatology,RH11
• autoimmuneillnessaffectingmultipleorgansystems
• incidence1/1,000,morecommonlyage>10,F:M=10:1
• childhood-onsetSLEvs.adult-onsetSLE:childrenhavemoreactivedisease,aremorelikelytohave
renal disease, and children receive more intensive drug therapy and have a poorer prognosis
Transient Synovitis of the Hip
• benign,self-limitedinflammatoryjointdisorder,usuallyoccursafterURTI,pharyngitis,AOM ■ key is to differentiate from septic arthritis
Epidemiology
• age3-10yr,M>F,morecommononrightside
Clinical Presentation
• afebrileorlow-gradefever,paintypicallyoccursinhips,knees(referredfromhip);painfullimpbutfull ROM (pain not as pronounced as in joint or bone infections), child does not look “toxic”
■ pain is not disabling and gradually worsens over few days, can have sudden onset of symptoms • symptomsresolveover7-10d
Investigations
• WBCwithinnormallimits;ESRandCRPmaybemildlyelevated • jointeffusionsmaybeseenonultrasound
■ aspirate joint and examine synovial fluid if suspicious for septic arthritis
■ MRI if suspicious for osteomyelitis or periarticular pyomyositis • diagnosisofexclusion
Treatment
• symptomaticandanti-inflammatorymedications ■ usually resolves with 24-48 h
Complications
• Legg-Calve-PerthesDisease
Pathogens
GBS, S. aureus, Gram negative bacilli Strep. spp., Staph. spp., H. influenzae
Pathogens as per neonate
S. aureus, S. pneumoniae, GAS As above; also N. gonorrhoeae
Treatment
cloxacillin + gentamicin OR cloxacillin + cefotaxime
cloxacillin + cefotaxime OR cefuroxime
Cefazolin OR cloxacillin OR clindamycin Ceftriaxone OR cefixime + azithromycin
Adapted from Tse SML, Laxer RM. Pediatrics in Review 2006;27:170-179