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snowfox...good contribution...
my humble thoughts....
we must add the following studies to the initial set of orders
CXR
12 Lead EKG
Echo
d-dimers and fibrinogen ( i do not know the indication ..maybe coz it's a vasculitis)
MRI and Dexa can be done later...once the diagnosis is established...
treatment would proceed as follows, depending upon severity
NSAIDS
METHOTREXATE
TNF...must do PPD prior to starting this class of drugs..
and of course...
Multi-Vits
Calcium supplements/ diet rich in calcium
HGB/Hematocirt f/u ( anemia of chronic dz)
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yes, you are right. we will add all those.
from e-medicine, it said the physical therapy is one of the important part of the therapy and the social worker. we need keep in mind.
about "d-dimers and fibrinogen", it said those lab will increase, I forgot what it is for?
good night.
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what is RATED SEX counselling stand for?
thanks
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Thanks Pindi and snow fox for all this nice work. As far as the treatment you first try NSAID for"Most patients who respond to NSAIDs will show clear improvement within the first three months [2]. Those who have not responded to initial NSAID therapy within three weeks should have the initial NSAID discontinued and a second NSAID begun. Unfortunately, there is no way to predict which NSAID is most likely to benefit an individual patient. A process of trial and error must be used while keeping expectations appropriate; patients should be aware that NSAIDs do not delay or prevent joint damage in JRA.In December 2006, the Arthritis Advisory Committee for the Food and Drug Administration (FDA) recommended FDA approval for the use of Celecoxib (COX-2 inhibitor) in children with JRA +
DMARDs, methotrexate( 4-8 weeks before u see clinical improvements)+folic acid to prevent glossitis.some physicians will concomitantly initiate therapy with a low dose (0.20 - 0.35 mg/kg per day) of prednisone, to be taken until the methotrexate has begun to take effect. The availability of the newer rapidly acting biologic agents has made this unnecessary in many cases. The newest labeling indications for both etanercept and adalimumab (anti-TNF therapies) do not require failure to respond to methotrexate before their use in children with JRA.
other combo treatments:both methotrexate and leflunomide(not a FDA aproved)
Sulfasalazine ” Sulfasalazine has been shown to be beneficial for many children with polyarticular JRA Patients who were in the sulfasalazine treatment group compared to those treated with placebo appeared to require less intensive DMARD treatment based upon a shorter duration of sulfasalazine (2.5 versus 5.2 years) and a trend to less use of methotrexate and other DMARD. At follow-up, assessment outcome scores were better in the group treated with sulfasalazine compared to the control group. However, more than one-third of patients in both groups reported long periods of non-compliance with DMARD, which significantly impacted upon patient outcome.
SUMMARY AND RECOMMENDATIONS ” Polyarticular JRA is defined by the presence of arthritis in more than four joints during the first six months of illness.
The clinical presentation of polyarticular onset JRA is varied and tends to fall into patterns based upon the age of onset. There is a bimodal distribution of the age at onset: the first peak in incidence is between the ages of 2 and 5 years, and the second peak between 10 and 14 years. JRA is more common in females than males.
The diagnosis is made on clinical grounds based upon the development of polyarthritis. There are no characteristic laboratory findings, although an elevated erythrocyte sedimentation rate (ESR, ≥40 mm/hr), anemia (hemoglobin concentration ≤11g/dL), and hypergammaglobulinemia may be present.
Recommendations ” With increasing experience utilizing combinations of drugs and the development of a number of biologic agents, it is apparent that our approach to children with polyarticular JRA will change dramatically over the next decade.
Our current recommendation is directed toward treating the underlying synovitis and associated inflammation as follows:
Initial therapy with non-steroidal inflammatory drug.
If there is no response to the initial NSAID by three weeks, the first NSAID is discontinued and a second NSAID is started.
If the patient continues to be unresponsive to NSAID therapy alone, a second line drug is recommended. We recommend the use of methotrexate at a dose of 10mg/m2 BSA/week or the use of a biologic agent that inhibits tissue necrosis factor (TNF).
With failure to respond to the above regimen, individualized therapeutic decisions are necessary. Consideration of different options, including the use of biologic agents, is recommended under the supervision of care providers with expertise in pediatric rheumatology. (See "Treatment of complications" above).
Therapy for specific complications including debilitating arthritis, uveitis, osteoporosis and growth retardation may also be required. (See "Treatment of complications" above). " The information above came from selective reading from UP do Date Lit. It it help me to do some reading on this topic thank u all.
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great. i would also add ferritin level
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