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Probability diagnosis

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Juvenile idiopathic arthritis (incl. still disease and psoriasis)

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Viral polyarthritis (e.g. parvovirus, rubella)

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Growing pains (leg)

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Irritable hip (transient synovitis)

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Traumatic arthritis

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Reactive arthritis (post-infective)

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Serious disorders not to be missed

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Vascular (haematological disorders):

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  • thalassaemia

  • sickle cell anaemia

  • haemophilia

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Infection:

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  • rheumatic fever

  • septic arthritis

  • osteomyelitis

  • meningococcaemia

  • tuberculosis

  • HIV

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Cancer:

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  • leukaemia

  • lymphoma

  • neuroblastoma

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Other:

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  • juvenile rheumatoid arthritis

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Pitfalls (often missed)

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Hip disorders:

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  • Perthes disease

  • slipped upper femoral epiphysis

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Osteochondritis dissecans

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Henoch-Schönlein purpura

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Kawasaki syndrome

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Rarities:

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  • scurvy

  • rickets

  • periodic fever syndrome

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Masquerades checklist

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Drugs (e.g. penicillins, cotrimoxazole)

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Spine: juvenile ankylosing spondylitis

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Key history and features in childhood

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Arthralgia (joint pain) is a common problem in childhood. The complaint demands respect because of the many serious problems causing it. Arthritis may be part of an infectious disease such as rheumatic fever, rubella, varicella, human parvovirus, influenza or other viral infection and is seen with Henoch-Schönlein purpura. Actually viral polyarthritis is very common in children. An FBE is helpful as it may show lymphopaenia, lymphocytosis or atypical lymphocytes.

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Diagnostic tips

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  • Acute onset monoarticular arthritis associated with fever is septic until proved otherwise.

  • 5% of all children complain of recurrent limb pain, which often awakens them from their sleep. A careful history and physical examination are essential and perhaps simple basic investigations may be appropriate.

  • Growing pains and post-activity musculoskeletal pain are relatively common.

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