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
joints 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 Joint inflamations
 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