Çocuk romatoloji polikliğine bacak ağrısı nedeni ile başvuran hastaların değerlendirilmesi: Tek merkez deneyimi

Year 2020, , 181 - 185, 01.06.2020

Semanur Özdel , Esra Bağlan , Mehmet Bülbül

https://doi.org/10.21601/ortadogutipdergisi.644329

Abstract

Amaç: Bacak ağrısı çocukluk çağında sık görülen bir yakınma olup çocuk romatoloji polikliniklerine sık başvuru nedenlerinden birisidir. Bu çalışmada bacak ağrısı ile çocuk romatoloji polikliniğine başvuran olguların etiyolojilerinin araştırılması ve sık görülen nedenlerin ortaya konması amaçlanmıştır.
Gereç ve Yöntem: Ağustos 2018 ile Ağustos 2019 tarihleri arasında bacak ağrısı nedeniyle çocuk romatoloji polikliniğine başvuran 270 hasta çalışmaya dahil edildi. Hastaların dosyaları geriye dönük olarak incelendi. Hastaların başvuru yakınmaları, demografik, klinik ve laboratuvar verileri önceden hazırlanmış formlara kaydedildi.
Bulgular: Çalışmaya %63’ü (n=170) kız olmak üzere 270 hasta dahil edildi. Hastaların ortalama yaşı ve ortalama yakınma başlama yaşı sırasıyla 10,4 ± 4,8 ve 9,1 ± 3,2 yıl bulundu. Bacak ağrısının en sık sebebi 74 (%27,4) hasta ile hipermobilite sendromuydu. Daha sonra sırasıyla 41 (%15) hastaya büyüme ağrısı, 39 (%14,4) hastaya Osgood-Schlatter hastalığı, 32 (%11,8) hastaya post-enfeksiyöz artrit/artralji, 28 (%10,3) hastaya fibromiyalji, 20 (%7,4) hastaya juvenil idyopatik artrit tanısı konuldu. On (%3,7) hasta akut romatizmal ateş, 2 (%0,74) hasta akut lenfoblastik lösemi tanısı aldı. Yaş grupları değerlendirildiğinde özellikle fibromyalji tanısı alan hastaların hepsi adolesan kız çocuğuydu. Bacak ağrılarının %62,5’i çift taraflıydı. Hastaların %44’ünde gerçekten bacak ağrısı varken diğer hastalarda başvuru yakınması bacak ağrısı olmasına rağmen asıl gösterilen yer bacaklar değil diz ve ayak bilek eklemleriydi.
Sonuç: Çocukluk çağında bacak ağrısı sık karşılaşılan bir yakınma olup sıklıkla hipermobilite sendromu ve büyüme ağrısı gibi inflamatuvar olmayan nedenlere bağlı olarak görülebilmektedir. Çalışmamızda da bacak ağrısının en sık sebebi hipermobilite sendromuydu. Özellikle adolesan dönemde Osgood-Schlatter hastalığı ve fibromiyalji, çocukluk döneminde ise büyüme ağrısı ön planda düşünülmelidir. Bu benign hastalıkların yanında özellikle eklemde şişlik olduğunda juvenil idyopatik artrit ve akut romatizmal ateş gibi hastalıklar da akılda tutulmalıdır. Yine nadir görülen hastalıklardan lösemiler, avasküler nekroz, meniskopatiler de bacak ağrısı ile başvurabilir. Sonuçta çocuklarda bacak ağrısı önemsenmesi gereken bir yakınma olup hastalar iyi sorgulanmalı ve ayırıcı tanı iyi yapılmalıdır.

Keywords

bacak ağrısı, büyüme ağrısı, hipermobilite, artrit

Evaluation of patients presenting with leg pain to the pediatric rheumatology polyclinic: A single center experience

Abstract

Objective: Leg pain is a common complaint in childhood and is one of the most common causes of admission to pediatric rheumatology outpatient clinics. The aim of this study was to analyze the demographic data and etiology of patients presenting with leg pain and to reveal common causes.
Material and Methods: The files of patients who presented to our pediatric rheumatology outpatient department between August 2018 and August 2019 due to leg pain were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients’ files and hospital database. An information form that collected data on patient gender and current age, age at disease onset, age at diagnosis was completed for all patients.
Results: The study included 270 patients with a mean age of 10.4 ± 4.8 years, including 170 (63%) females and 100 (37%) males. The mean age of onset of complaints was 9.1 ± 3.2 years. The most common cause of leg pain was hypermobility syndrome with 74 (27.4%) patients. Respectively, 41 (15%) patients were diagnosed with growing pain, 39 (14,4%) patients with Osgood-Schlatter disease, 32 (11,8%) patients with post-infectious arthritis / arthralgia, 28 (10,3%) patients with fibromyalgia, 20 (7,4%) patients with juvenile idiopathic arthritis. Two patients had acute lymphoblastic leukemia and 10 patients had acute rheumatic fever. All patients with fibromyalgia were girls and adolescents. 62.5% of leg pain was bilateral. 44% of patients really had leg pain. Although the complaint of presentation in other patients was leg pain, it was not the legs but the localized knee and ankles.
Conclusion: Leg pain is a common complaint both in childhood and adolescence. Hypermobility syndrome was the most common cause in both periods. Osgood-Schlatter disease and fibromyalgia should be considered especially in adolescence and growing pain in childhood. In addition to these benign diseases, diseases such as juvenile idiopathic arthritis and acute rheumatic fever should be considered, especially when the joint is swollen. Leukemia’s, avascular necrosis and meniscopathies may also present with leg pain. As a result, leg pain in children is a complaint that should be considered and patients should be questioned well and differential diagnosis should be made well.

Keywords

leg pain, growth pain, hypermobility, arthritis

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