- Inflammatory and noninflammatory conditions can cause joint pain in adolescents.
- Appropriate therapy for adolescents with arthritis requires not only treatment of the disease, but also attention to developmental needs and discussion of school and vocational issues.
There are many causes of joint pain occurring in childhood and adolescence (Table 5–1). Diagnostic accuracy is very important to ensure that the patient receives appropriate treatment.
Table 5–1. Differential Diagnosis of Arthritis in Adolescents. |Favorite Table|Download (.pdf)
Table 5–1. Differential Diagnosis of Arthritis in Adolescents.
- Lyme disease
- Septic arthritis
- Gonococcal arthritis
- Erythrovirus (parvovirus B19)
- Streptococcal-associated arthritis
- Acute rheumatic fever
- Hepatitis B and C
- Toxic synovitis
- Bone tumors
- Juvenile idiopathic arthritis (JIA)
- Polyarticular JIA
- Systemic-onset JIA
- Oligoarticular JIA (recurrent)
- Psoriatic arthritis
- Enthesitis-related arthritis (ERA)
- Arthritis of inflammatory bowel disease
- Reactive arthritis
- Juvenile-onset spondylitis
- Cystic fibrosis
- Sickle cell disease
- Connective tissue diseases
- Systemic lupus erythematosus
- Mixed connective tissue disease
- Noninflammatory conditions
- Chondromalacia patellae
- Hypermobility syndrome
- Avascular necrosis
- Skeletal dysplasias
- Slipped capital femoral epiphysis
- Osgood-Schlatter disease
- Sever disease
- Scheuermann disease
- Osteochondritis dessicans
- Synovial chondromatosis
- Synovial hemangioma
- Pigmented villonodular synovitis
The first step in evaluating a young patient who complains of musculoskeletal discomfort is to distinguish arthritis (true synovitis and joint swelling) from arthralgia (pain in and around joints). Pain in and around the joints without synovitis or swelling is usually caused by trauma, mechanical factors, or soft tissue syndromes. Excruciating joint pain and swelling, often with erythema, may indicate malignancy. A careful history of recent infections and exposures, as well as immunizations, can highlight possible infection-related causes of joint swelling and pain in the adolescent age group. Chronic childhood arthritis is one of the five most common chronic diseases of childhood, occurring with a frequency greater than diabetes or cystic fibrosis. Juvenile idiopathic arthritis (JIA), including psoriatic arthritis and the spondyloarthropathies of childhood, is the most common cause of chronic arthritis in childhood and adolescence.
The initial evaluation of an adolescent with a possible rheumatic disease includes a complete history and physical examination. In this age group, special attention should be paid to the following issues:
- Age at menarche.
- Is the patient skeletally mature? (A rough guide: is shoe size changing with every new pair?)
- Is the patient sexually active?
- Have there been prolonged or recurrent school absences?
- Are there barriers at school that make participation or attendance difficult?
- Has there been uninterrupted participation in physical education?
- Is there a history of participation in athletics?
- In what way does the patient make accommodations to compensate for arthritis symptoms (eg, wearing elastic waist sweat pants instead of jeans with buttons and zippers, avoiding going to the bathroom at school because of difficulty getting on and off the toilet).
- Does the patient have a best friend with whom she or he can discuss arthritis issues?...
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