Episode 131: Pediatric Rheumatology in the Pediatric ER, What to Ask, What to Check and What...

Описание: It is not often that I see a child with possible rheumatologic disease in the pediatric ER. What to ask, what to check for and what labs to order are always important things to think about. That is why I asked Dr. Robert Lowe to come on the show and discuss the management of those patients.

Dr. Lowe Advice on Labs to order when suspecting Rheumatological condition:

For suspected JIA.

Most important to confirm joint swelling on physical exam AND a history of one or more joints being swollen continuously for 6 weeks or longer.

Systemic JIA (only 15% of kids with JIA)

ESR and CRP are both elevated like you would see with an infection or with inflammatory bowel disease with the added presence of significant joint swelling and daily recurring high fevers (>102F usually) without other symptoms of infection for Systemic JIA.

For other systemic autoimmune disease

High ESR with normal or near normal CRP can suggest the presence of another systemic autoimmune disease such as SLE

D-dimer Ferritin LDH UA with Random protein to Cr ratio Dont order ANA and instead check ONLY the following:

· Double Stranded DNA (dsDNA) Ab, · Smith antibody (not Smooth muscle antibody), · Ribonuclear protein Ab (RNP Ab), · SSA and SSB Abs (Sjogrens syndrome antibodies)



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