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 w...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-Schtnlein 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.展开更多
文摘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-Schtnlein 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.
