Rheumatic Diseases of Childhood

The pediatrician frequently encounters children and adolescents with musculoskeletal complaints that raise the possibility of rheumatic disease. The purposes of this article are: to review an approach to the evaluation of "joint" symptoms and to review the pharmacology, use, and adverse effects of nonsteroidal anti-inflammatory drugs. RHEUMATOLOGIC HISTORY Systematic collection of the historical details is fundamental in the evaluation of "joint" complaints (Table 1). Age and Sex The child's age and sex provide initial clues. For example, suspicion that a young girl (less than 5 years of age) with knee swelling might have monoarticular juvenile rheumatoid arthritis is heightened simply because of her age and sex. (At onset of their disease, almost 20% of all patients with juvenile rheumatoid arthritis are young girls with pauciarthritis, most commonly involving the knee.) Suspicion that an older boy (10 years of age or older) with axioskeletal complaints might have an enthesopathy syndrome is increased, in part, because of his age and sex. of the age and sex predilections of various rheumatic conditions is, therefore, helpful. Chief Complaint The chief complaint is often directive. For example, the complaint "his knees hurt every night" or "his legs hurt at night" is not characteristic of children who have juvenile rheumatoid arthritis or other well-defined inflammatory arthritides.