MIŠIĆNOSKELETNI BOL KOD DECE - DIJAGNOSTIČKI IZAZOV U PEDIJATRIJSKOJ AMBULANTI
Ključne reči:
mišićnoskeletni bol, artritis, decaApstrakt
Mišićnoskeletni (MSk) bol je često patološko stanje sa kojim se suočava pedijatar u svakodnevnom ambulantnom radu. Najčešće se radi o benignim stanjima akutnog, samoograničavajućeg toka: bolovi rasta, hipermobilnost, različita ortopedska stanja, sindrom bolnog kolena, prolazna upala kuka i dr. Ukoliko bol prati otok zgloba, dijapazon patoloških stanja postaje znatno širi. Juvenilni idiopatski artritis je najčešće zapaljensko, reumatsko oboljenje u detinjstvu. Podrazumeva pojavu artritisa pre navršenog 16. rođendana, inflamaciju jednog ili više zglobova u trajanju od najmanje 6 nedelja. To je heterogena grupa oboljenja, koja se razlikuju u kliničkoj prezentaciji, etiopatogenetskom i prognostičnom smislu. Artritis se sreće i u sklopu različitih patoloških stanja: hematoloških, malignih, infektivnih, endokrinoloških idr. Zglobne tegobe mogu biti deo kliničke slike sistemskih bolesti vezivnog tkiva, uz koje se javljaju i druge vanzglobne manifestacije (sistemski eritemski lupus, dermatomiozitis, različiti vaskulitisni sindromi idr). Bol hroničnog trajanja prisutan je kod fibromialgije, kompleksnog regionalnog bola, koji su sa terapijskog aspekta veoma komplikovana bolna stanja. Pedijatar u primarnoj zdravstvenoj zaštiti je prvi kome se dete sa MSk bolom javlja. Izuzetno je važno da savlada tehniku pregleda MSk sistema, da poznaje algoritam laboratorijske obrade i metode vizualizacije koje mogu biti od koristi u dijagnostičkom postupku. Treba da bude upoznat sa diferencijalnom dijagnozom bola, kako da prepozna benigna stanja koja može da reši na primarnom nivou, a kada treba bolesnika uputiti na sekundarni i tercijerni nivo zdravstvene zaštite.
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