Joint pain in children is often harmless, but if the pain lasts, joints become hot, swollen or child stops, further investigation must be done

Definition

Pain in the joints of children, with or without joint swelling may be indicative of both transient, non-hazardous conditions and serious diseases. Initially, joint pain in children is considered closer:

• Are the pains new to a healthy child so far?
  • Investigations / investigations are required

• Is there an already known disease that can be associated with joint pain?
  • Closer examination of both joint and possible underlying disease may be necessary

• Have the pain lasted for several years without the health of the child otherwise significantly affected?
  • One must consider whether the pain is not due to physical illness and whether other measures are needed

Joint Swelling

Joint pain is common symptom in many different diseases. Objective, visible and palpable swelling often causes increased heat in the skin over the affected joint and suspects arthritis (joint inflammation). Also injuries and Bleeding in joint may cause similar symptoms. All investigations are based on medical history and a thorough medical examination in the first instance.

In the disease history (anamnese) it is of special interest (illness) if:

• Fever
• Abdominal pain
• Triggering reason
• Rash
• Weight Loss
• Eye symptoms

Some conditions that can give joint swelling in children

• Family Mediterranean Fever (FMF)
  • Ethnic background (Middle East, Mediterranean countries) and cases in the family
  • Affected fever, arthritis, serositis (stomach, lung, heart), high CRP, spontaneous decline after a few days
• Infection in joint
  • Bacteria in joints must be antibiotic-treated intravenously without delay (after necessary tests have been taken)
  • Inflammation tests (CRP), lowering reaction (SR) are high
  • Borrelia arthritis (Weeks-months after tick bite) occurs most often in the knee joint
    • Proven by joint examination and blood test
  • Fever, usually just one swollen joint
  • Pain, clearly increased heat and often redness above the joint
  • Rarely in multiple joints at the same time
  • Tuberkulosis (Tbc) in paragraph
  • Studies (MRI, ultrasound, CT, X-ray) show signs of joint damage after a short time
• Juvenile Arthritis (Childhood Arthritis)
  • The child limps, most clearly in the morning
  • Oligoarticular form: 1-4 joints are swollen
    • More often girls
    • Often ANA + in blood test
  • Polyarticular form: 5 or more joints are swollen

• • Systemic form (Stills disease)
    • Fever, arthritis, rash, high ferritin in blood samples
  • Arthritis with entesopathy: Tendon attachments (Achilles, plantar fascia), joints (knees, anchors, hips) and back inflammation (detected by MRI of sacroiliac joints from 12-15 years of age)
  • More often, boys
  • HLA-B 27 +
• Kawasaki vasculitis
  • Highly affected general condition with high fever, red tongue, swollen lymph nodes, red eyes, fingertips, heart attacked
• Cancer disease can rarely cause swollen joints
  • Strong pain in the skeleton may be present (especially night pain)
  • Inexplicable blood exudates and hematoma
  • Osteosarcoma, Lymphoma, Neuroblastoma, Leukemia can cause joint and skeletal pain
  • Investigation on advice from a department with experience in cancer diseases
  • Reactive arthritis
    • Few weeks after infection (throat, bowel, urinary tract)
      • Intestinal infection with Salmonella, Shigella, Yersinia or Campylobacter
      • Throat infection with streptococci
• Rheumatic fever (high fever and severe joint pain after sore throat with streptococci) has become very rare
•  Accident
  • Blood extravasation
  • Hemorrhage in joints (Hemarthorrhea)
    • After injury
    • In blood disease (haemophilia, platelet deficiency, Leukemia)
  • Fracture close to joints
  • Meniscus Injury (Sports)
  • ligaments Injury
• Systemic connective tissue diseases (ANA test in blood, other symptoms) are rare diseases among children.
  • Dermatomyositis in children
  • MCTD
  • Systemic Lupus Erythematosus (SLE) in children 
  • Sjøgren's syndrome in children
  • Systemic sclerosis / scleroderma in children
  • Bowel inflammation, chronic (Ulcerative colitis, Crohn's disease)
    • Stomach / intestinal symptoms
    • Knee and ankle swellings are most common
• Vasculitis diseases, andre (Kawasakis: please see above) in children
• Viral infections may initially resemble juvenile arthritis. Blood and joint fluid samples detect diseases
  • Parvovirus B19
  • Varicella (chickenpox virus)

Pain in joint (no joints) in children

Remember that "the most common is the most common". Growing pains (please see below) are seen in up to one in three children and are harmless. However, other symptoms should be investigated further.

• CRMO (very rare)
• CRPS (chronic regional pain syndrome) / Algody Strophy / Reflex Dystrophy / 
  • After minor damage
• Celiac Disease
  • Stomach / intestinal symptoms
• Epifysiolysis in the hip (slipped capital femoral epiphysis)
  • Puberty
• Fabry's disease
  • Strong and increasing pain and numbness in arms
  • Abdominal pain
  • Enzyme test
    • Level of  alpha-galactosidase Activity
• Hypermobility (hypermobile joints)
  • Hypermobility syndrome
  • Ehlers-Danlos syndrome
  • Marfan's syndrome
• Cancer
  • Children who begin to wake up at night with pain in joints or bones must be investigated to rule out illness:
  • Osteoid osteoma (Benign)
  • Osteosarcoma (Cancer, 60% in knees, children and adolescents)
  • Leukemia
• Add-Calvé-Perthes disease
  • Hofte, 3-10's age
• Lung or heart disease (with reduced oxygen uptake
• Osteochondrosis (Cartilage)
• Osteonecrosis (Avascular Bone Necrosis)
• Patellofemoral Syndrome
  • Pain under the kneecap
• Schlatter's disease
  • Just below the knee
  • Puberty
  • Exercise injury / overload
• Pain syndrome chronic
  • Painful muscles and aches
  • Fibromyalgia (Diagnosis rarely seen in children)
  • The pain has lasted for several years without the growth, weight or physical development being affected

• Bowel inflammation, chronic (Ulcerative colitis, Crohn's disease)
  • Stomach / intestinal symptoms
• Growing Pains
  • Up to one of three children
  • 3-12's age
  • Unknown cause
  • More localized to muscles / skeletal than in joints
  • Often late in the day or evening / night
  • Does not affect the shape in general
  • Non-persistent lameness, not swollen joints, no fever, no rash or bleeding, normal x-ray and normal blood tests
  • Reference: Evans AM, 2008

Adults with joint pain: Please read here

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