Selected causes of joint pain in childhood Infection ]Bacterial osteomyelitis± septic arthritis ] Mycobacterium ] Post viral (rubella, EBV, hepatitis B etc) ] Lyme arthritis

Selected causes of joint pain in childhood Malignancy XLeukemia XNeuroblastoma XOsteoid osteoma

Selected causes of joint pain in childhood Juvenile arthritis YSystemic JA YPauciarticular JA YPolyarticular JA YJuvenile spondylitis YJuvenile rheumatoid arthritis

Selected causes of joint pain in childhood Arthritis of other rheumatic diseases X Juvenile psoriatic arthritis X Dermatomyositis X Systemic lupus erythematosus (SLE) X Scleroderma X Mixed connective tissue disease (MCTD) X necrotizing vasculitis X Reflex dystrophy

Selected causes of joint pain in childhood “Reactive” arthritis X Reiter's syndrome X Rheumatic fever X Meningitis with H. Influenza: meningococcus

Selected causes of joint pain in childhood XHenoch Schonlein Purpura XKawasaki's disease

Selected causes of joint pain in childhood Arthritis associated with chronic diseases X Arthritis of inflammatory bowel disease X Cystic fibrosis X Sickle cell disease X Hemophilia X Thalassemia

Selected causes of joint pain in childhood Orthopedic causes Hip Xslipped capital femoral epiphysis XLegg-Calve-Perthes' disease Knee Xsynovial hemangioma Xdiscoid meniscus

Terminology / classification of juvenile arthritis Classic American classification (refers to juvenile rheumatoid arthritis –JRA) Systemic JRA Pauciarticular JRA Type I - ANA positive (young girls) Type II- HLA B27- positive (older boys) Polyarticular JRA Rheumatoid factor-negative (younger children) Rheumatoid factor-positive (older children)

Criteria for Classification of Juvenile Arthritis zAge of onset<16 years zArthritis in one or more joints defined as swelling or effusion, or presence of two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased heat zDuration of disease › 6 weeks

Criteria for Classification of Juvenile Arthritis XType of onset of disease during the first 6 months classified as: [a. Polyarthritis: 5 or more joints [b. Pauciarticular (oligoarthritis: 4 or fewer joints) [c. Systemic disease: arthritis with intermittent fever XExclusion of other forms of juvenile arthritis

Features of JA

Non JA causes of MSK pain in Children vHypermobility Syndrome vPes Planus vGenu recurvatum vPatellar dislocation vChondromalacia Patella vOsgood Schlatter disease vTenosynovitis vFrostbite arthritis vReflex Sympathetic Dystrophy (RSD( vGrowing pain vfibromyalgia

HLA Relationship in Children with JA

Systemic Onset juvenile arthritis Yfever100% Yarthritis100% Yrash95% Yhepatosplenomegaly85% Ylymphadenopathy70% Ypericarditis35% Ypleuritis20% Yabdominal pain10% Ymuscle pain5% Yuveitis<1%

Systemic Onset juvenile arthritis Xfatigue Xanemia Xanorexia Xleukocytosis Xhigh acute phase reactants

Spondyloarthropathy vlow back pain and stiffness vpauciarticular disease-small and large joints vasymmetry in joint involvement vpainful arthritis venthesitis vdactylitis vsacroileitis vlimitation of chest expansion vtenosynovitis vuveitis

ankylosing spondylitis SEA syndrome IBD Reiter's syndrome Psoriatic arthritis reactive arthritis

Comparison of juvenile spondyloarthropathies