Arthritis is a medical condition characterized by inflammation and swelling of the joints, resulting in pain and stiffness. While arthritis is commonly thought of as a disease of older adults, it can also affect children Pediatric arthritis is a broad term that encompasses several different subtypes of arthritis, each with its own unique symptoms and diagnostic criteria. The exact causes of pediatric arthritis are not well understood, but it is believed to be an autoimmune disorder in which the immune system mistakenly attacks the joints. Certain genetic and environmental factors may also play a role in the development of pediatric arthritis. Symptoms of pediatric arthritis can vary widely depending on the subtype and severity of the disease, but commonly include joint pain, stiffness, and swelling. Children with arthritis may also experience fatigue, fever, and difficulty with daily activities such as dressing, grooming, and playing. Diagnosis of pediatric arthritis typically involves a thorough medical history, physical examination, and blood tests to evaluate for markers of inflammation and autoimmune activity. Imaging tests such as X-rays, ultrasound, or MRI may also be used to evaluate the joints. Treatment for pediatric arthritis typically involves a multidisciplinary approach that includes medications, physical therapy, and occupational therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) may be used to reduce inflammation and prevent joint damage. In severe cases, biologic therapies may also be used to target specific immune system pathways. While pediatric arthritis can be a chronic and disabling condition, early diagnosis and treatment can help to minimize joint damage and improve outcomes for children with the disease. With proper care and management, many children with pediatric arthritis are able to lead active and fulfilling lives.

1. Differential Diagnosis
of
Arthritis in Children
Muhammad Wasil Khan
5-1/2018/066

2. TRAUMATIC JOINT PAIN
• This is more common in older children and adolescents
• It is frequently intermittent, exacerbated by exercise, and relieved by rest
• It is preceded by a history of trauma

3. ACUTE RHEUMATIC FEVER
• It is most common in children between 5 and 15 years of age
• Migratory arthritis affects several large joints in a quick succession.
• Each joint is affected for less than 1 week, while the entire polyarthritis
infrequently continues for more than 4 weeks
• It occurs after group A streptococcus pharyngitis by about 2–3 weeks

5. TRANSIENT SYNOVITIS OF THE HIP
• This is most common in male children aged 3–9 years
• It may be preceded by or occur concurrently with an upper respiratory
infection
• It commonly affects the hip joint, causing a limp, along with hip, thigh, or
knee pain
• The child appears nontoxic and able to move his hip through some range of
motion without pain, in contrast to septic arthritis and osteomyelitis

7. SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE)
• This is more common in adolescent females
• Arthritis is often asymmetric polyarthritis, involving both large and small
joints
• It is associated with other symptoms of SLE, such as the typical skin rash

9. HENOCH–SCHÖNLEIN PURPURA
• This is more common in males aged 3–10 years
• Usually, it occurs during the winter months
• Often, it follows an upper-respiratory tract infection
• Knee or ankle joint pain occurs in about 65% of patients
• It is associated with a purpuric rash on the buttocks and thighs
• Abdominal pain and hematuria occur in many children

11. HEMOPHILIA
• In hemophilia, hemarthrosis may occur
spontaneously or after a minor trauma
• It usually starts in the ankle joint. The knees
and elbows are also commonly affected in the
older child and adolescent

13. HISTORY
• Identity: Age, sex, ethnicity/race, residence
• Chief complaint: Joint pain

14. HISTORY OF PRESENTING COMPLAINT
1. Onset: Sudden or gradual
2. Duration: Acute (e.g., trauma) or chronic (may suggest a serious underlying
condition)
3. Timing of the pain: Nighttime, daytime, or in the morning on arising
4. Location and radiation of pain
5. Number of joints involved
6. Quality of pain
7. Severity of pain: Does it interfere with normal activities?

15. HOPC
8. Progression over time: Static, increasing, or decreasing
9. Intermittent or persistent, frequency of pain attacks, duration of each episode
10. Associated symptoms: Warmth, redness, swelling, morning stiffness, decreased
range of motion, limpness, refusal to walk, joint locking, joint giving way, fever, muscle
weakness
11. Aggravating and relieving factors: certain positions, activity (e.g., swimming), rest,
heat, or medications
12. Precipitating factors: A history of joint trauma, recent illnesses (e.g., gastroenteritis)
13. Pre-existing joint disease

16. PAST HISTORY
• Past history: History of trauma to the joint, prosthetic joint, previous
arthritis, blood dyscrasias, psoriasis, sickle-cell anemia, diabetes, rickets,
inflammatory bowel disease, celiac disease, chronic lung or cardiac disease
with hypoxia, cystic fibrosis, uveitis, tuberculosis exposure, sexually
transmitted disease exposure, surgery.

17. HISTORY
• Medication history: Recent use of medications, corticosteroids, nonsteroidal anti-
inflammatory drugs (NSAIDs), drug allergies
• Immunization history: Recent vaccination, such as H. influenzae immunization, MMR
• Family history: Family members with joint problems, sickle-cell anemia, hemophilia,
psoriasis, inflammatory bowel disease, spondyloarthropathies, or uveitis
• Social history: Recent travel or tick bite, sanitation, overcrowded house, intravenous drug
abuse, or child abuse
• Review of systems: Headache, fatigue, skin rash, chest pain, dyspnea, involuntary
movements, dysuria, hematuria, bloody diarrhea, malaise, red eyes, or weight loss

18. The pGALS assessment. Reproduced by kind permission of Arthritis Research UK (http://www.arthritisresearchuk.org) from: Foster HE, Jandial S. pGALS – A Screening
Examination of the Musculoskeletal System in School-Aged Children. Reports on the Rheumatic Diseases (Series 5), Hands On 15. Arthritis Research Campaign; 2008 June.

19. CASE 1
• A 5-year-old male child presents with a 1-day history of left-knee joint pain,
associated with swelling and decreased range of movement, after a minor
trauma. He had a history of excessive bleeding after circumcision

20. CASE 2
• A 4-year-old male child presents with knee pain, associated with a colicky
abdominal pain and purpuric rash on the buttocks and thighs. According to
the mother, the child had a history of an upper-respiratory tract infection
2 weeks prior to the onset of symptoms

21. CASE 3
• An adolescent female presents with pain and swelling of her right ankle and
interphalangeal joints of the index finger of the left hand, along with
associated photosensitive facial rash, mainly over the nose and cheeks. In the
last 3 days, she also developed a mouth ulcer.

22. CASE 4
• A 5-year-old male child presents with a limp and hip pain, preceded by upper
respiratory infection. The child is able to move his hip through some range
of motion without pain.

23. CASE 5
• A 7-year-old boy presents with a 2-week history of migratory joint pain and
swelling, affecting several large joints in a quick succession. Each joint was
affected for a few days. The child also has fever and chest pain. According to
the mother, there was a history of pharyngitis 3 weeks prior to the onset of
symptoms

24. CASE 6
• A10-year-old child presents with a 3-day history of right-knee pain. It is
intermittent, exacerbated by exercise, and relieved by rest. There was a
history of trauma to the joint.

25. Petty RE. Classification of childhood arthritis: a work in progress. Baillieres Clin Rheumatol. 1998 May;12(2):181-90. doi: 10.1016/s0950-3579(98)80013-7. PMID: 9890092.

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