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Selected causes of joint pain in childhood Infection

Selected causes of joint pain in childhood Infection. Bacterial osteomyelitis± septic arthritis Mycobacterium Post viral (rubella, EBV, hepatitis B etc) Lyme arthritis. Selected causes of joint pain in childhood. Malignancy Leukemia Neuroblastoma Osteoid osteoma.

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Selected causes of joint pain in childhood Infection

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  1. Selected causes of joint pain in childhood Infection • Bacterial osteomyelitis± septic arthritis • Mycobacterium • Post viral (rubella, EBV, hepatitis B etc) • Lyme arthritis

  2. Selected causes of joint pain in childhood Malignancy • Leukemia • Neuroblastoma • Osteoid osteoma

  3. Selected causes of joint pain in childhood Juvenile arthritis • Systemic JA • Pauciarticular JA • Polyarticular JA • Juvenile spondylitis • Juvenile rheumatoid arthritis

  4. Selected causes of joint pain in childhood Arthritis of other rheumatic diseases • Juvenile psoriatic arthritis • Dermatomyositis • Systemic lupus erythematosus (SLE) • Scleroderma • Mixed connective tissue disease (MCTD) • necrotizing vasculitis • Reflex dystrophy

  5. Selected causes of joint pain in childhood “Reactive” arthritis • Reiter's syndrome • Rheumatic fever • Meningitis with H. Influenza: meningococcus

  6. Selected causes of joint pain in childhood • Henoch Schonlein Purpura • Kawasaki's disease

  7. Selected causes of joint pain in childhood Arthritis associated with chronic diseases • Arthritis of inflammatory bowel disease • Cystic fibrosis • Sickle cell disease • Hemophilia • Thalassemia

  8. Selected causes of joint pain in childhood Orthopedic causes Hip • slipped capital femoral epiphysis • Legg-Calve-Perthes' disease Knee • synovial hemangioma • discoid meniscus

  9. Terminology / classification of juvenile arthritis Classic American classification (refers to juvenile rheumatoid arthritis –JRA) Systemic JRA Pauciarticular JRA Type I - ANA positive (young girls) Type II- HLA B27- positive (older boys) Polyarticular JRA Rheumatoid factor-negative (younger children) Rheumatoid factor-positive (older children)

  10. Criteria for Classification of Juvenile Arthritis • Age of onset<16 years • Arthritis in one or more joints defined as swelling or effusion, or presence of two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased heat • Duration of disease › 6 weeks

  11. Criteria for Classification of Juvenile Arthritis • Type of onset of disease during the first 6 months classified as: • a. Polyarthritis: 5 or more joints • b. Pauciarticular (oligoarthritis: 4 or fewer joints) • c. Systemic disease: arthritis with intermittent fever • Exclusion of other forms of juvenile arthritis

  12. Features of JA

  13. Non JA causes of MSK pain in Children • Hypermobility Syndrome • Pes Planus • Genu recurvatum • Patellar dislocation • Chondromalacia Patella • Osgood Schlatter disease • Tenosynovitis • Frostbite arthritis • Reflex Sympathetic Dystrophy (RSD( • Growing pain • fibromyalgia

  14. HLA Relationship in Children with JA

  15. Systemic Onset juvenile arthritis • fever 100% • arthritis 100% • rash 95% • hepatosplenomegaly 85% • lymphadenopathy 70% • pericarditis 35% • pleuritis 20% • abdominal pain 10% • muscle pain 5% • uveitis <1%

  16. Systemic Onset juvenile arthritis • fatigue • anemia • anorexia • leukocytosis • high acute phase reactants

  17. Spondyloarthropathy • low back pain and stiffness • pauciarticular disease-small and large joints • asymmetry in joint involvement • painful arthritis • enthesitis • dactylitis • sacroileitis • limitation of chest expansion • tenosynovitis • uveitis

  18. reactive IBD arthritis ankylosing Reiter's SEA syndrome spondylitis syndrome Psoriatic arthritis

  19. Comparison of juvenile spondyloarthropathies

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