Arthritis in Children and Adolescents

• Arthritis can be a manifestation of multiple disease processes. Therefore, the clinician must consider a broad differential diagnosis, keeping a high degree of suspicion for diseases that may have serious consequences. Although this article reviews more common disease processes that present with arthritis, it is imperative to think outside of the scope of infectious and musculoskeletal entities and consider autoimmune, oncologic, and other processes as well. • The diagnostician should use a complete history and physical examination to determine further evaluation. In most cases, the diagnosis can be confirmed by the constellation of supporting historic features, examination findings, and laboratory or imaging results. • Appropriate diagnosis and management of pediatric arthritis can facilitate prompt recovery and prevent debilitating consequences. Table 4 offers a brief summary for treatment management. • Strong research evidence suggests that delay in decompression of infected joints, especially the hips and shoulders, and delayed initiation of antibiotics are poor prognostic factors. • Moderate research evidence indicates that the presence of fever, inability to bear weight, ESR >40 mm/hour, and a white blood cell count >12x106 is highly suggestive of pyogenic arthritis. • Some evidence exists regarding safety and efficacy of the use of biologic agents in treating children who have JIA. • Based on expert opinion, an interdisciplinary approach to the treatment of JIA results in improved quality of life.