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The Child With Joint Pain Diagnostic Clues

The Child With Joint Pain Diagnostic Clues. Abraham Gedalia, M.D. Professor of Pediatrics Head, Division of Rheumatology Departments of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans New Orleans, LA.

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The Child With Joint Pain Diagnostic Clues

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  1. The Child With Joint Pain Diagnostic Clues Abraham Gedalia, M.D. Professor of Pediatrics Head, Division of Rheumatology Departments of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans New Orleans, LA Objectives: At the conclusion of this activity, the participants should be able to: 1. Discuss the approach to the child with joint pain or arthritis 2. Recognize the diagnostic clues of the different arthropathies 3. Develop strategy for the diagnosis

  2. Both lower extremities showing elevated, diffusepurplish-colored scaly rash

  3. 12 year-old AAF presented with findings of deforming polyarthritis, rash and irtis. She was known to have JRA since the age of 2 years

  4. Skin biopsy specimen revealing intradermal well-circumscribed, noncaseating epitheloid granulomata

  5. A higher magnification showing a multinucleated giant cell of Langhans’ typeSarcoidosis

  6. The Child With Joint Pain and/or Arthritis • IMPORTANT DIAGNOSTIC CLUES • Rashes • Enthesitis • Eye findings • Radiologic findings

  7. Ankylosing spondylitis Enthesitis

  8. The Child With Joint Pain • IMPORTANT DIAGNOSTIC CLUES • Rashes • Enthesitis • Eye findings • Radiologic findings

  9. Conjunctiva Vitreous Anterior Chamber Fovea Lens Pupil OpticNerve Cornea Iris Ciliary Body Retina Sclera Choroid

  10. Iritis of juvenile rheumatoid arthritis

  11. The Child With Joint Pain • IMPORTANT DIAGNOSTIC CLUES • Rashes • Enthesitis • Eye findings • Radiologic findings

  12. Radiologic findings in polyarticular JRA

  13. A 7- year-old Caucasian girl presents with 6-month duration of pain in the right hip associated with morning stiffness and limp Work-up reveals normal CBC, ESR-36 mm/h; ANA & RF, and HLA-B27 are negative Plain film of both hips is normal A bone scan shows increased tracer activity in the right hip area Patient was diagnosed with JRA and treated with naproxen but continues to complain of persistent right hip pain.

  14. Additional work-up including CT and MRI of the pelvis showed typical findings of Osteoid osteoma CT Scan CT SCAN MRI MRI

  15. MRI of the R hip showed precisely The location of the tumor radio lucent nidus

  16. Osteoid Oteoma 1. Osteoid osteoma is a common benign tumor of the bone that accounts for 2% to 3% of all primary bone neoplasms 2. Occurs in children and young adults, with age range of 5 and 20 years. Male > Female 3. The classical symptom is well-localized throbbing pain at night. Confusion can arise when the lesion is near a joint because it can mimic symptoms of arthritis or synovitis, thus leading to an incorrect diagnosis 4. The pain associated with osteoid osteoma is caused by the presence of abundant unmyelinated nerve fibers of the autonomic nervous system within the tumor nidus 5. Treatment is surgical, with en bloc excision of the tumor under Ct guidance

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