Juvenile idiopathic arthritis
Background
- Children <16yr
Clinical Features
- High fever (at least 102.2) for minimum of 2wk
- Faint erythematous macular coalescing rash
- Trunk, palms, soles
- Arthritis
- Usually polyarticular
- May also have hepatosplenomegaly, lymphadenopathy, pleuritis, pericardial effusion
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Polyarthritis
- Fibromyalgia
- Juvenile idiopathic arthritis
- Lyme disease
- Osteoarthritis
- Psoriatic arthritis
- Reactive poststreptococcal arthritis
- Rheumatoid arthritis
- Rheumatic fever
- Serum sickness
- Systemic lupus erythematosus
- Serum sickness–like reactions
- Viral arthritis
Evaluation
- Labs
- CBC (Anemia, leukocytosis, thrombocytosis)
- ESR, CRP
- Arthrocentesis may be needed to exclude septic arthritis
Management
- Initial therapy is ASA or NSAID
- Corticosteroids may be used if diagnosis certain, overwhelming systemic illness
Disposition
- Admit