Paediatrics & Child Health: Rheumatology

Presentations

• Gait disturbances
• Pain of musculoskeletal origin

Conditions

• Amplified pain syndromes:
  
  • juvenile fibromyalgia
  • regional pain syndromes
• Arthritis:
  
  • juvenile idiopathic
  • post-infectious or reactive
  • septic
  • viral
• Connective tissue diseases:
  
  • juvenile dermatomyositis
  • systemic lupus erythematosus
• Hip conditions, such as:
  
  • irritable hip
  • Perthes disease
  • slipped upper femoral epiphysis
• Localised scleroderma
• Rheumatic fever
• Vasculitic disorders:
  
  • Henoch–Schönlein purpura
  • Kawasaki disease

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

Presentations

• Hypermobility

Conditions

• Autoinflammatory diseases
• Ehlers–Danlos syndrome
• Macrophage activation syndrome
• Secondary osteoporosis
• Small vessel vasculitides, such as granulomatosis with polyangiitis and microscopic polyangiitis

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

• Anatomy and physiology of the musculoskeletal system
• Epidemiology and pathophysiology of arthritis
• Joint inflammation pathophysiology
• Normal joint structure and physiology
• Principle actions of common immunosuppressive agents
• Signs of clinical inflammation and the principles of monitoring disease activity in inflammatory rheumatic diseases

Investigations

• Investigations to diagnose immunologically-mediated disease, including autoimmune serology, such as:
  
  • anticyclic citrullinated peptide (anti-CCP) antibody
  • antidouble stranded DNA (anti-dsDNA)
  • antineutrophil cytoplasmic antibody (ANCA)
  • antinuclear antibody (ANA)
  • antiphospholipid antibodies
  • complement (C3 and C4)
  • extractable nuclear antigen (ENA)
  • rheumatoid factor (RF)
• Musculoskeletal MRI
• Skin and lesion biopsy

Procedures

• Synovial fluid analysis

• Long-term complications and outcomes of paediatric rheumatic diseases
• Multidisciplinary approach to the management of paediatric rheumatic diseases
• Role of DXA in the assessment of osteoporosis:
  
  • complications of long-term steroid use
  • interpretation of bone mineral density (BMD) results in relation to fracture risk and patient management