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Management of common MSK conditions - Coggle Diagram
Management of common MSK conditions
JIA
Acutely
A-E approach to ensure clinically stable
Management of symptoms, analgesia, anti-inflammatories, etc
Initial investigations
Diagnostic or Rule Out
FBC, film and LDH (rule out malignancy)
CRP, ESR
Imaging - not often required, although could use to rule out differentials, eg malignancy, if the history were suspicious.
CK, AST, ALT if suspicion of muscle disease
Baseline/to guide
response to subsequent management
LFTs
UEs
Infection screen for HIV, TB, Hep B, Hep C
Serology for functional antibodies and consider vaccines if negative
Prognostic
HLA B27 (risk of uveitis, enthesitis)
RF (more severe disease course)
ANA (higher risk of anterior uveitis)
Anti-dsDNA
THINK: jSLE
Anti-CCP
Higher risk of erosive disease
THINK also; jSLE, jDermatomyositis, Scleroderma, Systemic sclerosis
Early involvement of the MDT
Doctors
Consultant paediatrician
Tertiary or local rheumatology
Ophthalmology (risk of uveitis)
Nurses
Ward
CNS
AHPs
Physiotherapists
Others, eg nursery nurses, play therapists
Mindful of psychosocial aspects
Good explanations to the family
Looking into any prior social concerns or referrals
Subsequently
Bio
MInimisation of and monitoring for
the side effects of treatment
eg. Vigilence for infections
Regular blood tests
Keep an eye on growth and development
Disease control as soon as possible
Steroids
Intra-articular
Systemic
DMARDS, eg methotrexate
Biologics, eg adalimumab, infliximab
Supportive therapies
Physio
OT
Psycho
Social