MUSCULOSKELETAL PAIN IN CHILDREN - DIAGNOSTIC CHALLENGE IN OUTPATIENT CLINIC
Keywords:
musculoskeletal pain, arthritis, childrenAbstract
Musculoskeletal (MSk) pain is a common pathological condition which a pediatricians face in everyday practice. In most cases, those are benign condition: growing pains, hypermobility, various orthopedic conditions, transient hip synovitis, etc. If the pain accompained with swolling, the range of pathological conditions becomes wider. Juvenile idiopathic arthritis (JIA) is the most common inflammatory, rheumatic disease in childhood, implies the occurrence of arthritis before 16th birthday, inflammation of one or more joints for at least 6 weeks. The JIA comprises a heterogeneous group of inflammatory disorders, different in clinical presentation, etiopathogenetic and prognostic aspect. Arthritis can be clinical manifestation of other diseases: hematologic, malignant, infectious, endocrinological, and others. Joint’s pains are part of the clinical picture various systemic connective tissue diseases (systemic lupus erythematosus, dermatomyositis, vasculitis etc.). Chronic pain is present in fibromyalgia, complex regional pain syndrome, from a therapeutic point of view, very complicated painfull conditions. Pediatricians in primary health care are the first who face with this pathology. It is necessary to be familiar with MSk system examination, to know laboratory algorithm, as well as the immaging technics, that can be useful in the diagnostic procedure. It is very important to understand differential diagnosis of pain, how to recognize benign conditions that can be solved at the primary level, and when patients should be referred to the secondary and tertiary level of health care.
References
Tallen G, Bielack S, Henze G, Horneff G, Korinthenberg R, Lawrenz B, et al.Musculoskeletal Pain: A New Algorithm for Differential Diagnosis of a Cardinal Symptom in Pediatrics. Klinische Pädiatrie 2014; 226(02): 86–98. doi:10.1055/s-0034-1366989
Duey-Holtz AD, Collins SL, Hunt LB et al. Acute and non-acute lowerextremity pain in the pediatric population: part I. J Pediatr HealthCare 2012; 216-230216-30. doi: 10.1016/j.pedhc.2012.01.003PMID:22526001
Fuglkjær S, Dissing KB, Hestbæk L.Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review.BMC Musculoskelet Disord 2017 ;18(1):418. doi: 10.1186/s12891-017-1771-2. PMID:29047337
Paladino C, Eymann A, Llera J et al. Estimated prevalence of musculoskeletalpain in children, who attend a community hospital. ArchArgent Pediatr 200; 107: 515 – 519. DOI:10.1590/S0325-00752009000600008PMID:20049396
Pavone V, Vescio A, Valenti F, Sapienza M, Sessa G, Testa G. Growing pains: What do we know about etiology? A systematic review. World J Orthop. 2019;10(4):192-205. doi: 10.5312/wjo.v10.i4.192. PMID: 31041161;
Lehman PJ, Carl RL. Growing Pains. Sports Health. 2017;9:132–8. DOI:10.1177/1941738117692533; PMID:28177851.
Peterson H. Growing pains. Pediatr Clin North Am. 1986;33:1365–1372. DOI: 10.1016/s0031-3955(16)36147-8; PMID:3786003
Vehapoglu A, Turel O, Turkmen S, Inal BB, Aksoy T, Ozgurhan G, Ersoy M. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015; 24: 332-338 DOI: 10.1159/000431035; PMID: 26022378
Cook PC.Transient synovitis, septic hip, and Legg-Calvé-Perthes disease: an approach to the correct diagnosis.Pediatr Clin North Am. 2014;61(6):1109-18. doi: 10.1016/j.pcl.2014.08.002. PMID:25439014
Rossiter DJ, Ahluwalia A,VoP, Mapara R. The limping child: a systematic approach to assessment and management. Br J Hosp Med (Lond) 2018; 79(10):C150-C153. doi: 10.12968/hmed.2018.79.10.C150. PMID: 30290754.
Sekouris N, Angoules A, Koukoulas D, Boutsikari EC (2014) Hip Pain in Children, a Diagnostic Challenge: Transient Synovitis or Septic Arthritis in Early Stage? Emergency Med 4: 195. doi:10.4172/2165-7548.1000195
Weiss, JE, Stinson JN. Pediatric Pain Syndromes and Noninflammatory Musculoskeletal Pain. Pediatric Clinics of North America 2018;65(4):801–826. doi:10.1016/j.pcl.2018.04.004PMID 30031499
Grahame R, Bird HA, Child A. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol 2000;27 (7):1777-9. PMID:10914867
LeBlanc C, Houghton K. Noninflammatory Musculoskeletal Pain. In: Cassidy TJ, Petty ER, editors. Textbook of Pediatric Rheumatology. 5th ed. Philadelphia: W.B.Saunders Company; 2016; 660-680.
Sherry D. Pain amplification syndromes. In: Cassidy TJ, Petty ER, editors. Textbook of Pediatric Rheumatology. 5th ed. Philadelphia: W.B.Saunders Company; 2016. p.681-692.
Kaufman EL, Tress J, Sherry DD. Trends in Medicalization of Children with Amplified Musculoskeletal Pain Syndrome.Pain Med. 2017;18(5):825-831. doi: 10.1093/pm/pnw188.PMID:27497319
Cassidy TJ, Petty ER. Chronic Arthritis in Childhood. In: Cassidy TJ, Petty ER, editors. Textbook of Pediatric Rheumatology. 5th ed. Philadelphia: W.B.Saunders Company; 2016. p.206-260.
Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004;31(2):390-2.
Manners PJ, Bower C. Worldwide prevalence of JA:Why does vary so much? J Rheumatol 2002;29:1520-30. PMID:12136914
Budimir M. Juvenilni idiopatski artritis. Srpska knjiga. Beograd 2002.
Burgos-Vargas R. The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: A critical appraisal for the pediatric rheumatologist. Pediatr Rheumatol Online J. 2012 May 31;10(1):14. doi: 10.1186/1546-0096-10-14. PMID: 22650358
Butbul Aviel Y, Tyrrell P, Schneider R, Dhillon S, Feldman BM, Laxer R, Saurenmann RK, Spiegel L, Cameron B, Tse SM, Silverman E. Juvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis? Pediatr Rheumatol Online J. 2013 Mar 15;11(1):11. doi: 10.1186/1546-0096-11-11. PMID: 23497068
Susic G. et al. Analysis of Disease Activity, Functional Disability and Articular Damage in Patients with Juvenile Idiopathic Arthritis: A Prospective Outcome Study . Clin Exp. Rhematol 2011; 29 (2): 337-44. PMID: 21385554
Susic G, Vojinovic J, Vijatov-Djuric G, Stevanovic D, Lazarevic D, Djurovic N, Novakovic D, Consolaro A, Bovis F, Ruperto N; Paediatric Rheumatology International Trials Organisation (PRINTO). The Serbian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int. 2018;38(Suppl 1):347-354. doi: 10.1007/s00296-018-3972-x. PMID: 29637343;
Beaton A, Carapetis J. The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries. Heart Asia. 2015 Aug 19;7(2):7-11. doi: 10.1136/heartasia-2015-010648. PMID: 27326214;
Kamper SJ, Yamato TM, Williams CM. The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract Res Clin Rheumatol 2016;30(6):1021-1036. doi.org/10.1016/j.berh.2017.04.003 PMID:29103547
Shah SA, Saller J. Evaluation and Diagnosis of Back Pain in Children and adolescents. J Am Acad Orthop Surg. 2016;24 (1):37-45. doi:10.5435/JAAOS-D-14-00130. PMID: 26589458.
Foster HE, Jandial S.pGALS - paediatric Gait Arms Legs and Spine : a simple examination of the musculoskeletal system.Pediatr Rheumatol Online J. 2013 Nov 12;11(1):11-44. doi: 10.1186/1546-0096-11-44PMID: 24219838
