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The Child With Joint Pain Diagnostic Clues. Abraham Gedalia, M.D. Professor of Pediatrics Head, Division of Rheumatology Departments of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans New Orleans, LA.

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the child with joint pain diagnostic clues

The Child With Joint Pain Diagnostic Clues

Abraham Gedalia, M.D.

Professor of Pediatrics

Head, Division of Rheumatology

Departments of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans

New Orleans, LA

Objectives: At the conclusion of this activity, the participants should be able to: 1. Discuss the approach to the child with joint pain or arthritis

2. Recognize the diagnostic clues of the different arthropathies

3. Develop strategy for the diagnosis

slide2

The Child With Joint Pain

  • IMPORTANT FACTS
  • Musculoskeletal pain during childhood is common
  • According to population surveys, 16% of school-aged
  • children reported to have limb pain٭
  • Joint Pain has multiple etiologies
  • Early diagnosis and treatment is critical to prevent
  • complications
  • ٭ Cassidy Textbook of Pediatric Rheumatology 2005;37:704
slide3

The Child With Joint Pain

  • IMPORTANT QUESTIONS
  • How many joints are involved, is it one joint or many ?
  • Any associated fever ?
  • Any joint swelling ?
  • What is the duration of symptoms ?
  • Any associated morning stiffness, rash, mouth ulcers ?
  • Any associated muscle weakness ?
  • Any associated chest pain, abdominal pain, diarrhea ?
  • Any weight loss, skin bruises, and/or night pain ?
  • Any associated migraines and or sleep disturbances ?
  • Any associated eye problem ?
  • Any associated Trauma ?
slide4

The Child With Joint Pain

  • IMPORTANT QUESTIONS
  • How many joints are involved, is it one joint or many ?
  • Any associated fever ?
  • Any joint swelling ?
  • What is the duration of symptoms ?
  • Any associated morning stiffness, rash, mouth ulcers ?
  • Any associated muscle weakness ?
  • Any associated chest pain, abdominal pain, diarrhea ?
  • Any weight loss, skin bruises, and/or night pain ?
  • Any associated migraines and or sleep disturbances ?
  • Any associated eye problem ?
  • Any associated Trauma ?
slide5

The Child With Pain

Multiple Joint Involvement

Single Joint Involvement

With Fever

Septic arthritis/Osteomyelitis

Sympathetic arthritis

Foreign body with infection

Traumatic arthritis

Soft Tissue infection

Rheumatic Diseases

Reactive arthritis

Toxic synovitis

Diskitis

Sarcoidosis

Hemoglobinopathy

Malignancies

Without Fever

Trauma

Mechanical derangement

Rheumatic Diseases

Toxic synovitis

Avascular necrosis

Subacuteosteomyelitis

Diskitis

Hemoglobinopathy

Reflex sympathetic

dystrophy

Malignancies

Psychogenic pain

With Fever

Bacterial infections

Sepsis

Viral infections

Lyme disease

Reactive arthritis

Rheumatic diseases

Post immunization

Immune deficiencies

Serum sickness

Inflammatory bowel

disease

Sarcoidosis

Familial Mediterranean fever

Malignancies

Without Fever

Rheumatic diseases

Joint hypermobility

Growing pains

Post immunization

Immune deficiencies

Guilain-Barre

Lyme Disease

Fibromyalgia syndrome

Chronic fatigue syndrome

Psychogenic pain

Malignancies

slide9

JRA: Definition

a. Chronic pediatric arthropathies

b. Onset before 16 years of age

c. Presence of objective arthritis (in one

or more joints) for at least 6 weeks

Arthritis: Defined by swelling or effusion of joints, increased

warmth and/or painful limited movement with or

without tenderness

slide19

The Head of

the femur is

Slipping

slide26

Reflex sympathetic dystrophy

(RSD)

Bone scan

with technetium 99m

perfusion study

slide35

The Child With Joint Pain

  • IMPORTANT DIAGNOSTIC CLUES
  • 11 y/o Female with 4 week H/O joint pain & swelling
  • (elbows & R wrist). ESR: 93 mm/h; CRP: 5.8 mg/dl
  • Uric acid: 7.4 mg/dl; LDH: 1522 U/L
  • A bone scan with
  • abnormal increase
  • of tracer activity in
  • both fibulas and
  • left tibia
  • Bone marrow biopsy
  • shows near total
  • replacement of the
  • marrow with
  • leukemic cells
slide42

Suspected RheumaticConditions:DIAGNOSTIC TESTS

  • Body fluids
  • CBC, ESR, CRP, CMP
  • Rheumatoid factor
  • ANA / ANA Profile
  • Quantitative Immunoglobulins
  • HLA Typing
  • Muscle enzymes
  • ACE
  • Von Wllibrand factor antigen
  • ANCA
  • Genetic Mutations
  • Urine (UA, Prot / Creat)
  • Synovial Fluids
  • Ophthalmology (Slit lamp)
  • Other tests
  • CXR, CT, MRI, MRA, Bone
  • scan, Angiogram
  • EKG, ECHO
  • Tissue Biopsy
  • Bone marrow aspiration