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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Polyarthritis

Algorithm for Polyarticular arthralgia

• 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

See Also

• Hip Pain (Peds)