Juvenile idiopathic arthritis

Background

• Children <16yr

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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Diagnosis

Clinical Presentation

• 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

Work-Up

• Labs
  • CBC (Anemia, leukocytosis, thrombocytosis)
  • ESR, CRP
• Arthrocentesis may be needed to exclude septic arthritis

Treatment

• Initial therapy is ASA or NSAID
• Corticosteroids may be used if dx certain, overwhelming systemic illness

Disposition

Admit

See Also

Hip Pain (Peds)

Source

• Tintinalli