2025 – PAGE 425 – RHEUMATOLOGY

RAYNAUD’S PHENOMENON (AKA RAYNAUDS)

Raynaud’s phenomenon (AKA RAYNAUDS) will present as cyanosis and white/ulcerated finger tips due to lack of blood flow. The patient may especially be symptomatic in the cold.

PEARL: While this can be associated with scleroderma or systemic lupus erythematosus (SLE), it can also be a stand-alone diagnosis.

IMAGE: www.pbrlinks.com/RAYNAUDS1

GRANULOMATOSIS WITH POLYANGIITIS (AKA WEGENER’S GRANULOMATOSIS)

(Rare in kids, low-yield). Granulomatosis with polyangiitis is a multisystem vasculitis that affects the sinuses, lungs, and kidneys. Look for a +C-ANCA (as opposed to the p-ANCA seen in ulcerative colitis).

FIBROMYALGIA

Fibromyalgia is a chronic pain disorder. Children complain of “hurting everywhere” and have points of tenderness, called trigger points. Additional symptoms may include headaches, sleep disturbance, stiffness, fatigue and subjective joint swelling. There are no diagnostic tests, but a limited workup can be pursued to exclude other possible diagnoses (CBC, chemistry, ESR, CRP, TSH, UA). If there are joint complains, an ANA and a rheumatoid factor can be obtained. Treatment may involve recommendations on having structure to help living with this disease, routine exercise that is slowly increased in intensity over time and cognitive-behavioral therapy (CBT). Medications are usually not needed, but SSRIs may be prescribed.