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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.

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The Child With Joint Pain Diagnostic Clues

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  1. 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

  2. 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

  3. 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 ?

  4. 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 ?

  5. 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

  6. 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

  7. The Head of the femur is Slipping

  8. Reflex sympathetic dystrophy (RSD) Bone scan with technetium 99m perfusion study

  9. 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

  10. Diagnosis of benign joint hypermobility is confirmed if three of the five signs are present

  11. 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

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