Evaluation of the child with joint pain and/or swelling
- Yukiko Kimura, MD
Yukiko Kimura, MD
- Professor of Pediatrics
- Rutgers University - New Jersey Medical School
- Division Chief of Pediatric Rheumatology
- Joseph M Sanzari Children's Hospital
- Hackensack University Medical Center
- Taunton R Southwood, MD, FRACP, FRCPA, FRCP, FRCPCH
Taunton R Southwood, MD, FRACP, FRCPA, FRCP, FRCPCH
- University of Birmingham and Birmingham Children's Hospital
Joint pain and swelling are common manifestations of many musculoskeletal and rheumatologic diseases. As a result, the differential diagnosis of childhood joint pain and swelling is large and includes both benign and serious conditions. The assessment of a child with joint pain and/or swelling needs to differentiate between conditions of varying severity, especially those that require urgent medical intervention .
The evaluation of a child with joint pain or swelling is reviewed here. Although there is overlap among the causes of limping, hip pain, and joint swelling and pain, the causes and approaches to assessing a child with limp and/or hip pain are discussed separately. (See "Approach to the child with a limp" and "Overview of the causes of limp in children" and "Approach to hip pain in childhood".)
The differential diagnosis of childhood joint pain or swelling is broad, ranging from benign to serious conditions, some of which can have devastating consequences (eg, septic arthritis) (table 1). The categories of possible disease that may present with joint pain and/or swelling are included in the following mnemonic, ARTHRITIS:
●Avascular necrosis and epiphyseal disorders (see "Approach to hip pain in childhood", section on 'Legg-Calvé-Perthes and secondary avascular necrosis' and "Evaluation and management of slipped capital femoral epiphysis (SCFE)", section on 'Osteonecrosis')
●Reactive and postinfectious arthritis (see "Acute rheumatic fever: Clinical manifestations and diagnosis")
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- DIFFERENTIAL DIAGNOSIS
- INITIAL EVALUATION
- Worrisome findings
- - Fever
- - Pain, swelling, and stiffness characterization
- Location and number of involved joints
- Frequency, duration, and pattern
- - Other joint symptoms
- - Precipitating factors
- Antecedent trauma
- Antecedent infection
- Increased physical activity
- - Review of systems
- Physical examination
- - General appearance
- - Musculoskeletal screening
- - Focused joint examination
- Range of motion
- - Specific joints
- DIAGNOSTIC STUDIES
- Joint aspiration
- Laboratory testing
- - Acute joint pain
- - Chronic joint pain