QD 84 - Kid Arthritis Save
QD 84 - Kid Arthritis by Dr. Cush
Transcription
Hi. This is QD clinic brought to you by RheumNow live. I'm Jack Cush from RheumNow. Today's case, kid arthritis. 14 year old comes in with her mom.
Mom has rheumatoid arthritis. Worried about her child who's had joint pains going on for the last year. Exam, as you can imagine, largely unrevealing. A number of joints are tender, PIPs and shoulders and hips and knees, but really not much to show despite, you know, two hours of morning stiffness, polyarthralgia, no systemic features, a history of a prior, ligamentous tear, not necessarily provoked by trauma. So I learned this lesson like thirty years ago when seeing kids and I don't know what the diagnosis is because I'm not really finding much and I'm considering a diagnosis of myofascial pain syndrome or fibromyalgia in a child although they often don't have you know tender points I've been surprised by the diagnosis of hypermobility syndrome.
It's really quite common, in young adolescent females. It's easy to diagnose, you just have to look for it. And the way you look for it is typical signs of hypermobility, being able to bend your finger back and touch your your forearm, being able to bend your thumb inwards and touch the volar first surface of your forearm. I can't get there. I am not hypermobile.
Hyperextension of the elbow. So the it's actually the Bayton score, the Bayton criteria, which is five elements. One is hyperextension of the fifth metacarpal greater than 90 degrees, passive apposition of the thumb to the flexor aspect of the forearm, hyperextension of the elbows greater than 10 degrees, hyperextension of the knees greater than 10 degrees, and flexing the trunk and placing the hands flat on the floor. Those are all five of Baton score. And then you have to have four or more Baton score to meet Brighton's criteria along as as long as you have arthralgias and, marfanoid habitus and other musculoskeletal findings and extra articular findings.
That's what this patient had. Again, you should know that such patients, again, is more likely female, more likely, adolescents. They can have other things including ligamentous injuries, which this person had, either a marfanoid habitus, flat feet. They may have lens problems. The differential diagnosis is Ehlers Danlos, Marfan syndrome, osteogenesis imperfecta, homocystinuria, Rheumatic Fever or Acromegaly.
I'm reading from my textbook rheumatology.com or rktext.com and I think it's again, I refer to it all the time. You know, I heard something really smart from a colleague of mine the other day talking about teaching medical students or residents. He held up his cell phone and said, you know what? This is my my puck. Imagine it's a cell phone.
You know, they should make cell phones in the shape of a puck. Wouldn't that be cool? Especially for people who like hockey. Anyway, he holds up his cell phone to his residence and students says, I'm not gonna ask you anything that isn't already in this thing, so don't memorize anything. Just know how to use this thing, the phone, to find key information.
It's true. You know, rote memorization is a thing of the past. It helps to memorize stuff, but, you know, I mean, there's an information glut. Use the phone. You can use the phone to look up stuff on my textbook, rheumatology.com.
Anyway, interesting case, in an adolescent, I do see adolescents in kids because that was my interest in rheumatology and getting in was children with arthritis and Still's disease etc. So that's it for this week. Actually, we'll have one more episode of QD clinic tomorrow, and check out RheumNow live. The weather for next week, eight days away in Fort Worth. It's gonna be 75 and sunny or partly cloudy.
Let's pray for sun, but it'll be it's gonna be a good meeting in a great city. Hope you're there.
Mom has rheumatoid arthritis. Worried about her child who's had joint pains going on for the last year. Exam, as you can imagine, largely unrevealing. A number of joints are tender, PIPs and shoulders and hips and knees, but really not much to show despite, you know, two hours of morning stiffness, polyarthralgia, no systemic features, a history of a prior, ligamentous tear, not necessarily provoked by trauma. So I learned this lesson like thirty years ago when seeing kids and I don't know what the diagnosis is because I'm not really finding much and I'm considering a diagnosis of myofascial pain syndrome or fibromyalgia in a child although they often don't have you know tender points I've been surprised by the diagnosis of hypermobility syndrome.
It's really quite common, in young adolescent females. It's easy to diagnose, you just have to look for it. And the way you look for it is typical signs of hypermobility, being able to bend your finger back and touch your your forearm, being able to bend your thumb inwards and touch the volar first surface of your forearm. I can't get there. I am not hypermobile.
Hyperextension of the elbow. So the it's actually the Bayton score, the Bayton criteria, which is five elements. One is hyperextension of the fifth metacarpal greater than 90 degrees, passive apposition of the thumb to the flexor aspect of the forearm, hyperextension of the elbows greater than 10 degrees, hyperextension of the knees greater than 10 degrees, and flexing the trunk and placing the hands flat on the floor. Those are all five of Baton score. And then you have to have four or more Baton score to meet Brighton's criteria along as as long as you have arthralgias and, marfanoid habitus and other musculoskeletal findings and extra articular findings.
That's what this patient had. Again, you should know that such patients, again, is more likely female, more likely, adolescents. They can have other things including ligamentous injuries, which this person had, either a marfanoid habitus, flat feet. They may have lens problems. The differential diagnosis is Ehlers Danlos, Marfan syndrome, osteogenesis imperfecta, homocystinuria, Rheumatic Fever or Acromegaly.
I'm reading from my textbook rheumatology.com or rktext.com and I think it's again, I refer to it all the time. You know, I heard something really smart from a colleague of mine the other day talking about teaching medical students or residents. He held up his cell phone and said, you know what? This is my my puck. Imagine it's a cell phone.
You know, they should make cell phones in the shape of a puck. Wouldn't that be cool? Especially for people who like hockey. Anyway, he holds up his cell phone to his residence and students says, I'm not gonna ask you anything that isn't already in this thing, so don't memorize anything. Just know how to use this thing, the phone, to find key information.
It's true. You know, rote memorization is a thing of the past. It helps to memorize stuff, but, you know, I mean, there's an information glut. Use the phone. You can use the phone to look up stuff on my textbook, rheumatology.com.
Anyway, interesting case, in an adolescent, I do see adolescents in kids because that was my interest in rheumatology and getting in was children with arthritis and Still's disease etc. So that's it for this week. Actually, we'll have one more episode of QD clinic tomorrow, and check out RheumNow live. The weather for next week, eight days away in Fort Worth. It's gonna be 75 and sunny or partly cloudy.
Let's pray for sun, but it'll be it's gonna be a good meeting in a great city. Hope you're there.
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