Joint Exam
IWS
IPEP
Inspection:
EW
G: Short + obese (steroids), short and wasted (chronic inflammation)
O: cushingoid
D
Joints
Extraarticular manifestations of JIA/other diseases effecting joints
Ex Side effects of treatment
Skin
Upper limb
Hands
Axillary lymphadenopathy (Kawasaki's, Systemic JIA, SLE, Mixed CTD)
Head
Hair
Hoarse voice (laryngeal nodules JIA)
Parotid swelling (Sjögrens's, MCTD)
Lymphadenopathy (Kawasaki's, Systemic JIA, SLE, Mixed CTD)
Chest
Legs
Temperature (Systemic JIA)
Ix
Blood
- ANA
- Screen for MAS, HLH (WC low, Plt low, Ferritin >500, AST high, triglycerides high)
Urine
- Protein (PAN, HSP, SLE, Scleroderma, penicillamine, amyloidosis from inflammation)
- RC (PAN, HSP, SLE, naproxen)
Stool
- RC (HSP, IBD, dermatomyositis)
CXR for cardiomegaly/effusion
IPEP
Inspection:
EW
G: Short + obese (steroids), short and wasted (chronic inflammation)
O: cushingoid
D
Joints
Extraarticular manifestations of JIA/other diseases effecting joints
Ex Side effects of treatment
Skin
- Butterfly malar rash (SLE)
- Heliotrope eye lids (Dermatomyositis)
- Plaques (Psoriasis)
- Purpura (HSP, PAN)
- Salmon pink macules (systemic JIA)
- Nodules (JIA)
- Erythema nodosum (IBD)
- Subcutaneous calcinosis (scleroderma/dermatomyositis/SLE)
- Tight skin (scleroderma/MCTD)
- Salt and pepper (scleroderma)
Upper limb
Hands
- Subungal haemorrage (SLE)
- Pitting (psoriasis)
- Nail bed telangectasia (dermatomyositis)
- Dactylitis (Spondyloarthritis inc Psoriasis/AS)
- Raynaud's (SLE, MCTD, Scleroderma, PAN)
- Palmar palour (JIA, SLE, drugs)
- Flexor tenosynovitis (JIA)
- Flexor tendon nodules (Scleroderma)
- Epitrochlear nodes (Kawasaki's, Systemic JIA, SLE, Mixed CTD)
- Rheumatoid nodules (JIA)
Axillary lymphadenopathy (Kawasaki's, Systemic JIA, SLE, Mixed CTD)
Head
Hair
- Alopecia (SLE)
- Conjunctival palour
- Episcleritis, scleritis, scleromalacia perforans (seropos JIA)
- Cataracts (JIA, steroids, chloroquine)
- Uveitis, band keratopathy, abnormal pupil (Seroneg JIA)
- Retinopathy (chloroquine)
- Inflammed MM (SLE, dermatomyositis)
- Ulcers (SLE, penicillamine)
Hoarse voice (laryngeal nodules JIA)
Parotid swelling (Sjögrens's, MCTD)
Lymphadenopathy (Kawasaki's, Systemic JIA, SLE, Mixed CTD)
Chest
- Heart
- Cardiomegaly: myocarditis (Systemic JIA, SLE)
- Pericarditis: Pericardial rub (Systemic JIA, SLE)
- Murmur (SLE, SBE, ARF)
- Lungs
- Pleuritis: Pleural rub/effusion (Systemic JIA, SLE)
- Pain (serositis peritonitis of SLE, enteritis of IBD)
- hepatosplenomegaly (systemic JIA, SLE, mixed connective tissue)
- perianus (IBD)
- buttock purpura (HSP)
Legs
- Gait, Gowers, LL neuro
- UMN: atlantoaxial subluxation in JIA
- Proximal myopathy: Dermatomyositis, Steroids
Temperature (Systemic JIA)
Ix
Blood
- ANA
- Screen for MAS, HLH (WC low, Plt low, Ferritin >500, AST high, triglycerides high)
Urine
- Protein (PAN, HSP, SLE, Scleroderma, penicillamine, amyloidosis from inflammation)
- RC (PAN, HSP, SLE, naproxen)
Stool
- RC (HSP, IBD, dermatomyositis)
CXR for cardiomegaly/effusion