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Joint pain in children

We generally ignore the pain complaint by children and don't go to see the doctor for it. Pain perception and presentation may be very different in different child. Statistics showed that about 300,000 children under the age of 18 years are affected by joint pains, of which 50,000 children are victims of juvenile rheumatoid arthritis, or JRA.The commonest complaint for children is the knee pain.

The children may complaint of having:

  • Instant/Acute pain: This can be due to physical like fractures, thermal, electrical and chemical injuries like burns.
  • Chronic pain: The pain which is occurring for long time is a chronic pain.
  • i. Persisting pain: the pain that is continuous in nature example it may be due to a result of chronic diseases such as arthritis, rheumatologic disorders, or due to some side effect of drugs, even it can also be due to life threatening diseases like cancer.

    ii. Episodic:This is an on and off type of pain. It can be due to growing pain, juvenile arthritis etc.

In OPD's the children report for joint pain with 3 common causes:Rheumatic fever, fractures and juvenile arthritis. Growing pains is also a common complaint but, it always concentrates in the muscles, rather than the joints. The pain can be in front of the thighs, in calves, or behind the knees. The intensity of the pain varies from child to child. In most of the children, the pain onset is not fixed or say it does not comes every day.These are treated by nutritional supplement like vitamin D,calcium etc.

Rheumatic fever is basically, the disease of heart , which occurs after an infection of the throat with a group A streptococcus bacterium, tricks the immune system and results in inflammation of heart, skin or central nervous system, with red, hot swollen painful and tender joint.

Juvenile arthritis (JA) is a disease in which there is inflammation (swelling) of the synovium (tissue that lines the inside of joints) in children aged 16 or younger. Statistics showed that about 300,000 children under the age of 18 years are affected by joint pains, of which 50,000 children are victims of juvenile rheumatoid arthritis, or JRA1. The exact cause of juvenile arthritis is not known there for it is also called as Juvenile Idiopathic arthritis (JIA). It can be related to genetics, infections, and environmental triggers.Mainly five types of JA is found in children:

1. Systemic arthritis

2. Oligoarthritis

3. Polyarthritis

4.Psoriatic arthritis

5. Enthesitis-related arthritis

Systemic arthritis:Joint feels hot, or it may even feel warm to the touch.As the word suggest it affects and involves many systems or the entire body.Therefore, it usually causes high fever and a rash on the trunk, arms, and legs. The internal organs, involved are the heart, liver, spleen, and lymph nodes, but usually not the eyes.

Oligoarthritis:In the first six months of the disease initiation it affects up to five joints only. The joints most commonly affected are the knee, ankle, and wrist. It can also affect the eye, most often the iris. This is more common in girls than in boys. In most of the children the pain ceases itself by the time they become adults.

Polyarthritis:In the first six months of the disease, five or more joints start affecting and generally, the pair of joints are involved. This affect the joints in the jaw and neck as well as those in the hands and feet. This type of arthritis more closely resembles the adult form.

Psoriatic arthritis:Psoriasis is the skin disorder, when a child get arthritis before or after developing this disease, it is known as psoriatic arthritis.

Enthesitis-related arthritis:Entheses is the places where tendons attach to bones. In this type of arthritis the spine, hips, eyes, and entheses is affected. It occurs mainly in boys older than 8 years of age. It often runs in family with the history of ankylosing spondylitis (arthritis of the back).

The approach to diagnose the child's joint pain depends on two main factors: the number of joints involved and the presence of fever. Then, think of different causes which can affect the joint locally or systematically.2

CHILD WITH JOINT PAIN (Some major causes)
SINGLE JOINT INVOLVEMENT MULTIPLE JOINT INVOVEMENT
With Fever Without Fever With Fever Without Fever
Septic/ traumatic arthritis Trauma Bacterial or viral infection Growing pains
Soft tissue infection Avascular necrosis Immune deficiencies fibromyalgia
Reactive arthritis Psycogenic pain Sepsis Rheumatic disease
Toxic synovitis Mechanical derangement Inflammatory bowel diseases Post immunization
Malignancies Malignancies Malignancies Malignancies
CHILD WITH JOINT PAIN (Some major causes)
SINGLE JOINT INVOLVEMENT
With Fever Without Fever
Septic/ traumatic arthritis Trauma
Soft tissue infection Avascular necrosis
Reactive arthritis Psycogenic pain
Toxic synovitis Mechanical derangement
Malignancies Malignancies
MULTIPLE JOINT INVOVEMENT
With Fever Without Fever
With Fever Without Fever
Immune deficiencies fibromyalgia
Sepsis Rheumatic disease
Inflammatory bowel diseases Post immunization
Malignancies Malignancies