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Features distinguishing juvenile idiopathic arthritis among children with musculoskeletal complaints
Satita Jeamsripong1, Sirirat Charuvanij2
1Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Morning stiffness lasting 15 minutes or more is a key indicator for diagnosing juvenile idiopathic arthritis (JIA) in children with musculoskeletal complaints. Early diagnosis and treatment are crucial for better long-term outcomes.
Area of Science:
- Pediatric Rheumatology
- Pediatric Orthopedics
- Clinical Pediatrics
Background:
- Musculoskeletal (MSK) complaints in children encompass a wide range of conditions, from minor issues to serious diseases.
- Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children, often initially presenting with MSK symptoms.
- Timely diagnosis and treatment of JIA are critical for preventing long-term disability.
Purpose of the Study:
- To identify distinguishing features of JIA in pediatric patients with MSK complaints.
- To characterize the spectrum of diseases presenting with MSK complaints in a tertiary care setting.
Main Methods:
- Retrospective chart review of pediatric rheumatology consultations.
- Study period: July 2011 to June 2015.
- Inclusion of patients evaluated at a single tertiary center.
Main Results:
- Out of 531 patients, 285 (53.6%) presented with MSK complaints.
- The most common complaints were joint pain (86.3%), limping (33%), and refusal to walk (19.6%).
- JIA was diagnosed in 73 patients (25.6%), with other common diagnoses including Henoch-Schönlein purpura (16.1%), reactive arthritis (14.2%), and systemic lupus erythematosus (13.7%).
Conclusions:
- Morning stiffness of 15 minutes or longer is a significant predictor of JIA.
- Thorough patient history and physical examination are essential for diagnosing JIA in children with MSK complaints.
Background:
Musculoskeletal (MSK) complaints in children vary, ranging from benign, self-limited conditions to serious disorders. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease, initially presenting with MSK complaints. Delayed diagnosis and appropriate treatment have an enormous impact on the long-term outcomes and the level of disability. This study aimed to identify the features distinguishing JIA among children presenting with MSK complaints and to describe the spectrum of diseases at a large, single, tertiary center.
Methods:
A retrospective chart review was performed of patients evaluated by pediatric rheumatology consultation at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, from July 2011 to June 2015.
Results:
Of 531 patients, 285 (53.6%) had at least one MSK complaint. The mean age of the patients was 9.1 ± 4.1 years. Joint pain was the most common MSK complaint (86.3%), followed by limping (33%) and refusal to walk (19.6%). Joint swelling and limited range of motion were found in 146 (51.2%) and 115 (40.4%) patients, respectively. Seventy-three (25.6%) patients were diagnosed as JIA. The other common diagnoses included Henoch-Schönlein purpura (16.1%), reactive arthritis (14.2%), and systemic lupus erythematosus (13.7%). Morning stiffness ≥ 15 minutes [odds ratio (OR) 8.217 (3.404-19.833)]; joint swelling on MSK examination [OR 3.505 (1.754-7.004)]; a duration of MSK complaints of more than 6 weeks [OR 2.071 (1.120-3.829)]; and limping [OR 1.973 (1.048-3.712)] were significantly associated with the ultimate diagnosis of JIA.
Conclusions:
Morning stiffness ≥ 15 minutes is a strong predictor of JIA. Comprehensive history taking and an MSK examination will provide clues for making the ultimate diagnosis for children with MSK complaints.
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