Retrospective Evaluation of Children Presenting with Joint Pain

Year 2022, , 229 - 235, 29.12.2022

Hilal Seda Yılmaz , Vesile Energin , Bülent Ataş , Ozge Metin

https://doi.org/10.26650/jchild.2022.1130084

Abstract

Objective: Joint pain is a common symptom in children, and many diseases can cause arthralgia. The aim of our study was to retrospectively investigate the diagnostic distribution of children admitted to pediatric outpatient clinics with arthralgia and to examine the relationship between the current COVID-19 pandemic and joint pain.Material and Methods: The mean age of 293 patients was 125.9±51.3 months. 52.9% of the patients were male and 47.1% were female. In our study, 55.6% of 293 patients presented with arthritis and 44.3% with arthralgia. When the patients presenting with arthralgia were diagnostically listed, brucellosis (11.9%) was the first, reactive arthritis (8.8%) was the second, and juvenile idiopathic arthritis (8.5%) was the third most common. The most likely diagnosis was brucellosis in the patient who presented with arthralgia in the knee, juvenile idiopathic arthritis, Henoch-Schönlein purpura in the ankle, and arthralgia in the hip. 20 patients had positive COVID-19 polymerase chain reaction (PCR) and 5.1% of the patients were diagnosed with arthralgia due to COVID-19 infection.Results: Of 293 patients included in the study, the mean age was 125.9±51.3 months. Of the patients, 52.9% were male and 47.1% female, with a male/female ratio of 1/1.2. Of 293 patients in our study, 55.6% were found to have arthritis and 44.3% arthralgia. The most common diagnosis established was brucellosis, with a frequency of 11.9%, followed by reactive arthritis with 8.8% and juvenile idiopathic arthritis with 8.5%. The most likely diagnosis was determined to be juvenile idiopathic arthritis, Henoch Schönlein purpura and brucellosis in patients presenting with arthralgia of knees, ankles and hips, respectively. 20 patients had positive COVID-19 polymerase chain reaction (PCR) and 5.1% of the patients were diagnosed with arthralgia due to COVID-19 infection.Conclusion: In our study, the most common diagnosis in patients presenting with joint pain was brucellosis. The high rate of brucellosis is associated with the prevalence of raw milk products and animal husbandry in Konya and its surrounding provinces. This should be kept in mind in the differential diagnosis in regions such as our country and our region, where there is still intense brucellosis, and the use of pasteurized milk and products should be encouraged. Infectious causes should be included in the differential diagnosis of COVID-19 in patients presenting with arthralgia.

Keywords

Joint Paint, arthritis, brucellosis, arthralgia, child

Eklem Ağrısı ile Başvuran Çocuklara Tanısal Yaklaşım

Abstract

Amaç: Eklem ağrısı çocuklarda sık görülen bir semptomdur ve birçok has-talık artraljiye neden olabilir. Çalışmamız amacı pediatri polikliniklerine artralji ile başvuran çocukların tanısal dağılımının retrospektif olarak araş-tırılması ve içinde bulunduğumuz COVİD-19 pandemisinin eklem ağrısı ile ilişkisini incelemekti. Gereç ve Yöntem: Bu çalışmada Ocak 2020- Aralık 2021 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı çocuk genel ve yandal (romatoloji, enfeksiyon, hematoloji/onkoloji, acil) polikliniklerine eklem ağrısı ile başvuran 293 hasta retrospektif olarak incelendi. Hastaların başvuru şikayetleri, fizik muayeneleri, laboratuvar tetkikleri, radyolojik görüntülemeleri ve sonuç durumu değerlendirildi. İstatistiksel analizler için SPSS 23.0 programı kul-lanıldı. Bulgular: 293 hastanın yaş ortalaması 125,9±51,3 aydı. Hastaların %52,9’u erkek, %47,1’i kızdı. Çalışmamızda 293 hastanın %55,6’sı artrit, %44,3’ü artralji ile başvurmuştur. Artralji ile başvuran hastalar tanısal sıralandığın-da ilk sırada bruselloz (%11,9) ikinci sıklıkla reaktif artrit (% 8,8), üçüncü sıklıkla juvenil idyopatik artrit (%8,5) gelmekteydi. Dizde artralji ile başvu-ran hastada juvenil idyopatik artrit, ayak bileğinde Henoch-Schönlein purpurası, kalçada artralji ile başvuran hastada en olası tanı brusellozdur. 20 hastanın COVİD-19 polimeraz zincir reaksiyonu (PCR) pozitif gelmiş olup hastaların %5,1’i COVİD-19 enfeksiyonuna bağlı artralji tanısı almıştır.Sonuç: Çalışmamızda eklem ağrısı ile başvuran hastalarda en sık görülen tanı bruselloz olmuştur. Brusellozun yüksek oranda olması Konya ve çevre-sindeki illerde çiğ süt ürünleri ile beslenme ve hayvancılıkla uğraşmanın yaygın olması ile ilişkilidir. Ülkemiz ve bölgemiz gibi halen yoğun bruselloz görülen bölgelerde ayırıcı tanıda akılda mutlaka bulundurulmalı ve pastö-rize süt ve ürünleri kullanılması teşvik edilmelidir. Artralji ile başvuran hastalarda enfeksiyöz nedenlerden COVİD-19’da ayırıcı tanıda yer almalıdır.

Keywords

Eklem ağrısı, artrit, bruselloz, artralji, çocuk

References

• 1. Davies K, Copeman A. The spectrum of paediatric and adolescent rheumatology. Best Practice & Research Clinical Rheumatology 2006;20(2):179-200. google scholar
• 2. Onat Ş. Eklem Ağrılı Çocuklarda Tanısal Yaklaşım. Abant Tıp Dergisi 2014;3(2):201-9. google scholar
• 3. Weiss JE, Stinson JN. Pediatric Pain Syndromes and Noninflammatory Musculoskeletal Pain. Pediatr Clin North Am 2018;65(4):801-26. google scholar
• 4. Balan S. Approach to Joint Pain in Children. Indian J Pediatr 2016;83(2):135-9. google scholar
• 5. Sen ES, Clarke SL, Ramanan AV. The child with joint pain in primary care. Best Pract Res Clin Rheumatol 2014;28(6):888-906. google scholar
• 6. Bourgaize S, Newton G, Kumbhare D, Srbely J. A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. J Can Chiropr Assoc 2018;62(1):26-41. google scholar
• 7. Fidancı İ, Güleryüz Od, Tokgöz A. Çocuk Acil Servise Düşmeye Bağlı Travma Nedeniyle Getirilen Olgular. Pediatric Practice and Research 2021;9(1):5-10. google scholar
• 8. Kasapçopur Ö. Eklem ağrısı ile başvuran çocukta ayırıcı tanı. Türkiye Aile Hekimliği Dergisi 2011;14(3):109-14. google scholar
• 9. Sultanoğlu Te, Ataoğlu S, Avşar B, Çakır Mn. Fiziksel Tıp ve Rehabilitasyon Polikliniğine Başvuran 18 Yaş Altı Hastaların Değerlendirilmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 11(1):56-60. google scholar
• 10. Sevilir Burucu R. 2005-2010 yıllarında İstanbul Tıp Fakültesi çocuk acil ve genel pediatri polikliniğine başvuran 2-10 yaşları arası çocuklarda artrit/artralji sıklığı ve etyolojisi.Uzmanlık Tezi, İstanbul, 2012. google scholar
• 1. Kaya Akca U, Atalay E, Cuceoglu MK. Impact of the COVID-19 pandemic on the frequency of the pediatric rheumatic diseases. Rheumatol Int 2022;42(1):51-7. google scholar
• 12. Abdwani R, Abdalla E, Al Abrawi S, Al-Zakwani I. Epidemiology of juvenile idiopathic arthritis in Oman. Pediatr Rheumatol Online J 2015;13(1):33. google scholar
• 13. Riise Ø R, Handeland KS, Cvancarova M. Incidence and characteristics of arthritis in Norwegian children: a population-based study. Pediatrics 2008;121(2):e299-306. google scholar
• 14. Tiller G, Buckle J, Allen R . Juvenile idiopathic arthritis managed in the new millennium: one year outcomes of an inception cohort of Australian children. Pediatr Rheumatol Online J 2018;16(1):69. google scholar
• 15. Alzyoud RM, Alsuweiti MO, Almaaitah HQ, Aladaileh BN, Alnoubani MK, Alwahadneh AM. Juvenile idiopathic arthritis in Jordan: single center experience. Pediatr Rheumatol Online J 2021;19(1):90. google scholar
• 16. Rumsey DG, Laxer RM. The Challenges and Opportunities of classifying childhood arthritis. Curr Rheumatol Rep 2020;22(1):4. google scholar
• 17. Ballı H, İbrahim E. Van bölgesinde çocukluk çağı artritlerinin tanısal dağılımı. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi 2020;6(2):190-6. google scholar
• 18. Noah PK, De Ceulaer K. Arthritis in childhood. A report on 65 consecutive cases observed at the University Hospital of the West Indies. West Indian Med J 1989;38(1):17-22. google scholar
• 19. Kıplapınar N,Aydoğan G. Çocukluk çağı artritlerinin etyolojisi. Uzmanlık Tezi. İstanbul, 2009. google scholar
• 20. Caksen H, Arslan S, Oner AF . Childhood brucellosis is still a severe problem in the eastern region of Turkey. Trop Doct 2002;32(2):91-2. google scholar
• 21. Park MJ, Lee J, Lee JK, Joo SY. Prevalence of Vitamin D deficiency in Korean children presenting with nonspecific lower-extremity pain. Yonsei Med J 2015;56(5):1384-8. google scholar
• 22. Vehapoglu A, Turel O, Turkmen S. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015;24(4):332-8. google scholar
• 23. Louvigné M, Rakotonjanahary J, Goumy L. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatr Rheumatol Online J 2020;18(1):1. google scholar
• 24. Tamashiro MS, Aikawa NE, Campos LM, Cristofani LM, Odone-Filho V, Silva CA. Discrimination of acute lymphoblastic leukemia from systemic-onset juvenile idiopathic arthritis at disease onset. Clinics (Sao Paulo) 2011;66(10):1665-9. google scholar
• 25. Brix N, Hasle H, Rosthøj S, Herlin T. Characteristics of children with acute lymphoblastic leukemia presenting with arthropathy. Clin Rheumatol 2018;37(9):2455-63. google scholar
• 26. Hasan LK, Deadwiler B, Haratian A, Bolia IK, Weber AE, Petrigliano FA. Effects of COVID-19 on the Musculoskeletal System: Clinician’s Guide. Orthop Res Rev 2021;13:141-50. google scholar
• 27. Tan JY, Conceicao EP, Sim XYJ, Wee LEI, Aung MK, Venkatachalam I. Public health measures during COVID-19 pandemic reduced hospital admissions for community respiratory viral infections. J Hosp Infect 2020;106(2):387-9. google scholar
• 28. Marino A, Cimaz R. Long Coronavirus disease in pediatric rheumatology. The Pediatric İnfectious Disease Journal 2022;41(1):e30. google scholar