Clinical Case Vignettes: Arthritis in Children
Didactic learning teaches us a lot, but we learn the most from our patients. This chapter provides a case-based learning of children with arthritis, with key take-home messages after each vignette.
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Sharath Kumar
Learning Objectives
Case Vignette
1. Didactic learning teaches us a lot, but we learn the most from our patients. This chapter provides a case-based learning of children with arthritis, with key takehome messages after each vignette
C a 10-year-old boy presented to the emergency with fever and joint pains for 10 days. His ASO titer done by his primary physician was positive (>200 IU/ml); thus he was referred with a diagnosis of rheumatic fever.
Introduction We have learnt in the prior sections of this book that musculoskeletal pain is a common problem among children [1]. There are various causes of these pains, as elucidated in the prior sections, with only a small minority of children having juvenile idiopathic arthritis [2]. Thus, the ability to detect childhood arthritis among the multitude of children with chronic musculoskeletal pain is a skill which needs to be mastered to prevent long-term morbidity and mortality which are associated with some causes of joint pain in children. In this chapter case vignettes of patients with different diseases presenting with arthritis are discussed.
S. Kumar, MBBS, MD, GCPR, DNB (Rheumat) Columbia Asia Hospitals, Bengaluru, Karnataka, India e-mail: [email protected]
Almost all disorders in rheumatology lack a gold standard diagnostic laboratory or radiological investigation. This can prove quite challenging in daily practice. Rheumatological laboratory tests have been found to lack both specificity and sensitivity. The antistreptolysin-O antibody test (ASO test) similarly lacks sensitivity and specificity. The ASO is a serological test which determines the level of a neutralizing antibody in the serum to an antigen on Group A beta-hemolytic streptococcal cell surface. This antibody is elicited in 70–85 % of individuals infected with Streptococcus. The titers begin to rise by the end of 1 week after infection and reach a peak between 3 and 5 weeks after the infection with titers remaining high for at least 2–3 months [3]. Thus the antibody may not be present in 15–30 % of infected individuals. The result may be negative if tested too early in the infection. It may be not suggestive of acute infection if the patient had a past infection with Streptococci
© Springer Science+Business Media Singapore 2017 S. Sawhney, A. Aggarwal (eds.), Pediatric Rheumatology, DOI 10.1007/978-981-10-1750-6_23
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in the last 4–6 weeks. The normal range is also variable and depends upon the age of the patient, geographical locale, and the season of the year [4]. A titer more than the upper limit of normal for the specific patient group being studied and a value greater than 333 Todd units or fourfold or higher rise in titer when tested at 2-week interval are all useful cutoffs to detect a clinically meaningful positive ASO titer. C had an ASO report of >200 IU. The test was done by the commonly used latex agglutination method. This is poorly standardized method of testing for the antibody titer. The nephelometric method has also not been prope
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