Features distinguishing juvenile idiopathic arthritis among children with musculoskeletal complaints
- 66 Downloads
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.
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.
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.
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.
KeywordsJoint pain Juvenile idiopathic arthritis Limping Morning stiffness Musculoskeletal
SJ contributed to concept and design, acquisition of data, analysis and drafting the manuscript. SC contributed to concept and design, acquisition of data, analysis, interpretation of data, drafting and revising the manuscript and corresponding author. Both authors approved the final version of the manuscript.
Compliance with ethical standards
Research procedures were performed in accordance with the Declaration of Helsinki. Ethical approval for the study was obtained from Siriraj Institutional Review Board (Si 325/2016), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Conflict of interest
No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
- 8.Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.Google Scholar
- 21.Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis. 2010;69:798–806.CrossRefGoogle Scholar
- 24.Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N, Childhood Arthritis Rheumatology Research Alliance, et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011;63:929–36.CrossRefGoogle Scholar
- 28.Poddighe D, Cavagna L, Brazzelli V, Bruni P, Marseglia GL. A hyper-ferritinemia syndrome evolving in recurrent macrophage activation syndrome, as an onset of amyopathic juvenile dermatomyositis: a challenging clinical case in light of the current diagnostic criteria. Autoimmun Rev. 2014;13:1142–8.CrossRefGoogle Scholar
- 37.Arkachaisri T, Tang SP, Daengsuwan T, Phongsamart G, Vilaiyuk S, Charuvanij S, et al. Paediatric rheumatology clinic population in Southeast Asia: are we different? Rheumatology (Oxford). 2017;56:390–8.Google Scholar