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  1. T R Southwood

    Rheumatic symptoms, such as limping or limb pain, are common in children, yet childhood arthritis and other rheumatic diseases are rare. Diagnosis and treatment of these conditions therefore require a high level of clinical awareness and careful assessment. Laboratory investigations are rarely pathognomonic and are used instead to help differential diagnosis, to detect complications, and to monitor disease activity. Drug treatment depends on a sound knowledge of the variable nature and prognosis of the conditions and a clear understanding of the pharmacology, risks, and benefits of anti-inflammatory and antirheumatic drugs in children.

    Diagnosis of juvenile chronic arthritis

    All three of these criteria must be met:

    • Arthritis persisting for more than three months

    • Onset of arthritis before age 16

    • Exclusion of other diseases that may cause arthritis

    Arthritis is defined as:

    • Swelling of at least one peripheral joint or

    • At least two of the following signs—limited range of movement, tenderness or pain on movement of joint, or increased warmth of skin overlying joint

    Persistent swelling of joints characterises a heterogeneous group of diseases termed juvenile chronic arthritis, formerly known as Still's disease. This group of diseases is, for the most part, genetically and clinically distinct from rheumatoid arthritis in adults. About one child in every 1000 has juvenile chronic arthritis, amounting to over 12000 affected children in Britain. Each year one new case would be expected in every 10000 children.

    Children with arthritis may not complain of pain, but most do experience some discomfort

    The diagnosis of juvenile chronic arthritis is often difficult initially because swelling of joints may be subtle or absent and complaints of pain may be difficult to elicit from children. Children may present with limping, upper limb dysfunction, torticollis, or non-specific constitutional symptoms such as lethargy, fever, poor appetite, or irritability. Occasionally, features not associated with the musculoskeletal system may predominate: rash, pericarditis, serositis, or organomegaly. Prompt diagnosis and an early start of appropriate treatment are …

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