CHICAGO—When it comes to correctly diagnosing joint pain in children, “things take time,” said Michael L. Miller, MD, quoting Danish physicist and poet Piet Hein. Children with pain but normal physical examinations may need to return to the clinic for repeat evaluation over several months. “I often tell parents that laboratory tests may help in diagnosis, but they’re a guide in children and adolescents. I say, ‘In the absence of a diagnosis, we are in a monitoring phase.’”
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During Arthralgia in the Pediatric Patient, a session at the 2018 ACR/ARHP Annual Meeting, Dr. Miller, clinical practice director, Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital, Chicago, shared his experience in managing children with musculoskeletal pain syndromes and communicating with children and parents.
When a physical examination is unremarkable, rheumatologists should ask about the child’s recent history of school absences due to pain, which will quickly distinguish children with musculoskeletal pain syndromes from those who have early juvenile idiopathic arthritis (JIA). “Children with [musculoskeletal pain syndromes] are often anxious about returning to school, while children with JIA are often depressed about missing school,” he said.