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Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children.
Pediatrics. 2002 Aug; 110(2 Pt 1):354-9.Ped

Abstract

OBJECTIVE

To examine complaints for which children were referred to a pediatric rheumatology service and to determine whether there are specific complaints that are more likely to indicate the presence of chronic arthritis or chronic, systemic inflammatory disease.

METHODS

A retrospective chart review of 414 children referred to the pediatric rheumatology service at the Children's Hospital of Oklahoma from April 1998 to July 2001.

RESULTS

Musculoskeletal pain was the most common complaint for which children were referred (n = 226). Of these, 111 had musculoskeletal pain as an isolated complaint. One of these children had a chronic inflammatory disease. Another 115 children had pain as 1 of several reasons for seeking a rheumatology consultation, including positive results on laboratory tests (antinuclear antibody, erythrocyte sedimentation rate, and rheumatoid factor). Nineteen of these children had a chronic inflammatory disease, including 12 with juvenile rheumatoid arthritis (JRA). Thus, musculoskeletal pain as a presenting complaint had a strong negative predictive value for the presence of either JRA (0.95) or any other chronic inflammatory disease that might be characterized by arthritis. Children who were referred, in part, because of positive antinuclear antibody and/or rheumatoid factor tests were no more likely to have a chronic inflammatory disease than children who did not include such results as a reason for referral. Joint swelling, in contrast, was the most likely complaint to be associated with a diagnosis of JRA.

CONCLUSIONS

Musculoskeletal pain was the most common reason for referral to our pediatric rheumatology clinic. However, isolated musculoskeletal pain, in the absence of other signs or symptoms, is almost never a presenting complaint of children with chronic forms of arthritis. Children with arthritis more commonly present with complaints of joint swelling and/or gait disturbance. Neither ANA nor rheumatoid factor evaluations were useful in evaluating children with musculoskeletal complaints.

Authors+Show Affiliations

Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12165590

Citation

McGhee, Julie L., et al. "Identifying Children With Chronic Arthritis Based On Chief Complaints: Absence of Predictive Value for Musculoskeletal Pain as an Indicator of Rheumatic Disease in Children." Pediatrics, vol. 110, no. 2 Pt 1, 2002, pp. 354-9.
McGhee JL, Burks FN, Sheckels JL, et al. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002;110(2 Pt 1):354-9.
McGhee, J. L., Burks, F. N., Sheckels, J. L., & Jarvis, J. N. (2002). Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics, 110(2 Pt 1), 354-9.
McGhee JL, et al. Identifying Children With Chronic Arthritis Based On Chief Complaints: Absence of Predictive Value for Musculoskeletal Pain as an Indicator of Rheumatic Disease in Children. Pediatrics. 2002;110(2 Pt 1):354-9. PubMed PMID: 12165590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. AU - McGhee,Julie L, AU - Burks,Frank N, AU - Sheckels,Julie L, AU - Jarvis,James N, PY - 2002/8/8/pubmed PY - 2002/9/17/medline PY - 2002/8/8/entrez SP - 354 EP - 9 JF - Pediatrics JO - Pediatrics VL - 110 IS - 2 Pt 1 N2 - OBJECTIVE: To examine complaints for which children were referred to a pediatric rheumatology service and to determine whether there are specific complaints that are more likely to indicate the presence of chronic arthritis or chronic, systemic inflammatory disease. METHODS: A retrospective chart review of 414 children referred to the pediatric rheumatology service at the Children's Hospital of Oklahoma from April 1998 to July 2001. RESULTS: Musculoskeletal pain was the most common complaint for which children were referred (n = 226). Of these, 111 had musculoskeletal pain as an isolated complaint. One of these children had a chronic inflammatory disease. Another 115 children had pain as 1 of several reasons for seeking a rheumatology consultation, including positive results on laboratory tests (antinuclear antibody, erythrocyte sedimentation rate, and rheumatoid factor). Nineteen of these children had a chronic inflammatory disease, including 12 with juvenile rheumatoid arthritis (JRA). Thus, musculoskeletal pain as a presenting complaint had a strong negative predictive value for the presence of either JRA (0.95) or any other chronic inflammatory disease that might be characterized by arthritis. Children who were referred, in part, because of positive antinuclear antibody and/or rheumatoid factor tests were no more likely to have a chronic inflammatory disease than children who did not include such results as a reason for referral. Joint swelling, in contrast, was the most likely complaint to be associated with a diagnosis of JRA. CONCLUSIONS: Musculoskeletal pain was the most common reason for referral to our pediatric rheumatology clinic. However, isolated musculoskeletal pain, in the absence of other signs or symptoms, is almost never a presenting complaint of children with chronic forms of arthritis. Children with arthritis more commonly present with complaints of joint swelling and/or gait disturbance. Neither ANA nor rheumatoid factor evaluations were useful in evaluating children with musculoskeletal complaints. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/12165590/Identifying_children_with_chronic_arthritis_based_on_chief_complaints:_absence_of_predictive_value_for_musculoskeletal_pain_as_an_indicator_of_rheumatic_disease_in_children_ L2 - https://publications.aap.org/pediatrics/article-lookup/doi/10.1542/peds.110.2.354 DB - PRIME DP - Unbound Medicine ER -