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The child with joint pain in primary care
E S Sen1, S L N Clarke1, A V Ramanan2
1Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK.
Best Practice & Research. Clinical Rheumatology
|June 23, 2015
Summary
Pediatric joint pain requires careful evaluation to distinguish benign causes from serious conditions like malignancy or infection. A thorough history, physical exam, and targeted tests are crucial for early diagnosis and appropriate management.
Area of Science:
- Pediatric Rheumatology
- Pediatric Orthopedics
- Pediatric Oncology
Background:
- Joint pain is a frequent pediatric primary care complaint with a broad differential diagnosis.
- While often benign, some causes of pediatric joint pain indicate serious conditions requiring early detection.
Purpose of the Study:
- To provide primary care physicians with a diagnostic algorithm for evaluating pediatric joint pain.
- To guide appropriate investigations and referrals for children presenting with joint pain.
Main Methods:
- Review of clinical presentation, diagnostic workup, and referral pathways for pediatric joint pain.
- Development of a diagnostic algorithm based on clinical assessment and evidence.
Main Results:
- A thorough history and directed examination are paramount.
- Laboratory tests (CBC, ESR, CRP, LDH) aid in diagnosing malignancy, infection, or inflammation; autoimmune screens are not recommended for juvenile idiopathic arthritis.
- Imaging (radiographs for fractures/SUFE, ultrasound for effusions) plays a key role.
Conclusions:
- A systematic approach is essential for managing pediatric joint pain in primary care.
- Appropriate use of investigations and timely referral to specialists are critical for optimal outcomes.
Keywords:
Juvenile idiopathic arthritisPaediatric Gait, Arms, Legs, Spine (pGALS)Perthes' diseaseSeptic arthritisSlipped upper femoral epiphysisMore Related Videos
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