The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / How to Proceed When Kids Present with Joint Pain but Normal Exams

How to Proceed When Kids Present with Joint Pain but Normal Exams

January 17, 2019 • By Susan Bernstein

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Juvenile Arthritis

Often, rheumatologists use the 1997 classification criteria to diagnose children with JIA, a group of diseases that lasts for six weeks or longer in children ages 16 years or younger. These diseases include systemic JIA, oligoarthritis, polyarthritis, psoriatic arthritis, enthesitis-related arthritis (ERA) and undifferentiated arthritis.1

You Might Also Like
  • Arthralgias in Children: What to Do When Kids Present with Joint Pain
  • Growing Up Confident with Juvenile Idiopathic Arthritis
  • Keep Kids on the Move
Explore This Issue
January 2019
Also By This Author
  • Medical Tech-Tool Usage Is Surging

In systemic JIA, “there may be a delay before synovitis develops, often up to several months,” Dr. Miller said. Children with oligoarticular JIA may also have arthralgias for weeks or months before synovitis develops, as well as atrophy of extensor muscles. “These children may require splinting. This is a group in whom uveitis occurs—often asymptomatic,” he said.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Children with polyarticular JIA often have arthritis that affects the small joints in their hands and cervical spine, and typically have a chronic disease course. A subset of children with clinical oligoarticular arthritis exists, and these children have a more aggressive, chronic disease course, said Dr. Miller. “None of the JIA subtypes are homogenous. Children with JIA may need physical or occupational therapy and also splinting.”

‘School absences suggest the possibility of a pain syndrome.’ —Dr. Miller

Children with enthesitis may present with arthritis followed by enthesitis or pain over the attachment of tendons or ligaments to bone, such as over the Achilles tendons or plantar fasciae. Some children with other JIA subtypes can also present with enthesitis in addition to synovitis, Dr. Miller noted.

“It’s actually rare that we see advanced spine disease resulting in ankylosis in children with [enthesitis-related arthritis]. I’ve only seen this a couple of times in boys who were HLA-B27 positive,” said Dr. Miller. “Enthesitis may take months or even years to manifest.”

Magnetic resonance imaging (MRI) is an effective tool to detect joint erosions and bone marrow edema in children with enthesitis-related arthritis. And there may be a family history of the disease, he said.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Laboratory Tests

Differential diagnosis helps determine which laboratory tests to order, said Dr. Miller. Consider SLE in differential diagnosis for children who present with arthralgias as well.

Up to half of children with active synovitis and juvenile arthritis have normal erythrocyte sedimentation rates, he stressed.2 Over time, repeat blood tests may help diagnose the cause of unexplained pain.

“I’ve had patients with normal differentials who then had neutropenia on a subsequent test. One child had leukemia. Children with leukemia don’t always have abnormal blood tests, so it may be helpful to repeat these tests over a few months while they’re having symptoms. There are cases of children with leukemia presenting with a definite synovitis, but usually the pain is over the metaphysis,” said Dr. Miller.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports Tagged With: 2018 ACR/ARHP Annual Meeting, arthralgia, Children, Joint Pain, PediatricsIssue: January 2019

You Might Also Like:
  • Arthralgias in Children: What to Do When Kids Present with Joint Pain
  • Growing Up Confident with Juvenile Idiopathic Arthritis
  • Keep Kids on the Move
  • Patient Fact Sheet: Juvenile Idiopathic Arthritis

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.