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THE PEDIATRICS CLERKSHIP - PART 9

Hệ thống cá hồi hồng điểm vàng phát ban. Hệ thống các triệu chứng: viêm khớp, gan lách to, tăng bạch cầu, và polyserositis. Nhiều tập, xoá các tính năng hệ thống trong vòng 1 năm. ĐIỀU TRỊ Mục tiêu của điều trị là để khôi phục lại chức năng, giảm đau, và duy trì chuyển động liên. | TABLE 19-2. Joint fluid analysis. Disorder Cells pL Glucose Trauma RBC WBC 2 000 WBC Normal Reactive arthritis 2 000-10 000 mononuclear WBC Normal Rheumatoid factor RF tends to be negative in early childhood in JRA. RF is positive in about 15 of patients usually when onset of polyarticular disease occurs after the age of 8 years. A normal ESR does not exclude the diagnosis of JRA. Routine ophthalmologic screening should be performed every 3 to 6 months for 4 years for all children with arthritis to look for iridocyclitis. The presence of HLA-B27 is a major determinant of disease severity in Reiter s syndrome and a predictor of recurrence. Juvenile rheumatoid 5 000-60 000 WBC mostly neutrophils Low to normal arthritis Septic arthritis 60 000 WBC 90 neutrophils Low to normal Reproduced with permission from Hay et al. Current Pediatric Diagnosis and Treatment 14th ed. New York McGraw-Hill 2002. Systemic Salmon-pink macular rash. Systemic symptoms arthritis hepatosplenomegaly leukocytosis and polyserositis. Episodic remission of systemic features within 1 year. Treatment The goal of treatment is to restore function relieve pain and maintain joint motion. NSAIDs Range-of-motion and muscle strengthening exercises Methotrexate anti-tumor necrosis factor TNF antibodies or antipyrimidine medication for patients who do not respond to NSAIDs REITER S SYNDROME Definition Triad of asymmetric arthritis urethritis and uveitis. Etiology Thought to be a reactive arthritis after infection with gram-negative Salmonella Shigella Yersinia Campylobacter Chlamydia Mycoplasma and Ure-aplasma in persons with human lymphocyte antigen HLA -B27. Diagnosis Bone density is preserved. Proliferative bone formation is present. I CHILDHOOD FRACTURES NOT RELATED TO ABUSE Torus Fracture Figure 19-6 Buckle fracture Impaction injury in children in which the bone cortex is buckled but not disrupted Stable fracture 338 TORUS FIGURE 19-6. Torus fracture. Greenstick Fracture Figure 19-7 Angulation beyond .