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

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)








Please consider contributing to PEM Rules at


https://ko-fi.com/pemrules


And check out www.pemrules.com (http://www.pemrules.com/)


Copyright PEM Rules LLC


DISCLAIMER


By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.


This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.