Rheumatoid & SLE

S. Yudha Patria Dept. Pediatric Fac. Medicine, Gadjah Mada University, Yogyakarta

Juvenile Rheumatoid Arthritis (JRA)

JRA type
Acute febrile form or systemic form:
episodic febrile, pink macular rash, arthritis, hepatosplenomegaly, leukocytosis

Polyarticular form:
symetrical chronic pain & many joints swelling, sub-febrile, fatigue, anemia

Pauciarticular form:
asymetric pain and joint swelling

Diagnosis
Clinically Lab: - Blood count - Rheumatoid factor ( + in 15% especially in older children) - ANA (antinuclear antibody) test Imaging: Ro, Ctscan, etc

Differential Diagnosis
Traumatic joint injury Acute joint infection SLE Neoplastic disease

Treatment
Exercise and physiotherapy to restore joint function and maintain mobility NSAIDs medication, if unresponsive use methotrexate, Local and/or systemic corticosteroid

Systemic Lupus Erythematosus (SLE)

Common in girls 9 -15 years

Pathogenesis
Soluble immune complexes deposited in tissue (many tissues) attract lymphocytes & neutrophyl inflammation in multiple systems: joint, skin, kidney, heart, lung, liver, CNS, etc Symptoms:
weight lost, fatigue, fever, joint paint, malar butterfly rash, renal disease, karditis, ensefalitis, amenorrhea, etc

Butterfly rash

Diagnostic
Clinicaly Lab: - routine blood exam:
anemia, leucopenia, thrombocytopenia, elevated ESR - ANA test

Imaging: USG, CTscan

Differential Diagnosis
Rheumatoid arthritis Viral infection

Treatment
Corticosteroid reduce morbidity & mortality from renal, cardiac, and CNS SLE NSAIDs Cyclophosphamide in corticosteroid resistant case