Suspected haemarthrosis in a known or suspected haemophiliac (haematology). Suspected septic arthritis (orthopaedics). Avoid NSAIDS during diagnostic workup, as these may mask migratory joint symptomsĬonsider consultation with local paediatric team when. An echocardiogram is required even if no clinical murmur to exclude subclinical carditis. All suspected cases should be discussed with a paediatrician experienced in ARF, ID physician or paediatric cardiologist. For infective causes, refer to the appropriate sub-specialist team and consult. Septic arthritis is an orthopaedic emergency - consult local orthopaedic team. Definitive management is determined by the working diagnosisĪcute pain management and consider immobilization. Suggested diagnostic approach to acute joint swelling based on clinical features Investigations will be guided by the clinical features – with suggestions summarised in the flow chart below. A clear working diagnosis and/or a plan to review within 7 days. Repetitive injury, recurrent subluxation/dislocation Urticarial type rash, but can also present with papular or purpuric rashįever, weight loss, lethargy, fatigue, anorexia, night sweats,Īt risk for vitamin D deficiency (poor sunlight exposure/dark skin, predisposing medical conditions)įever, diarrhoea, weight loss, uveitis, abdominal pain 
Serum sickness/ Serum sickness like reactions Preceding upper respiratory joint infection Purpuric rash (normally affecting lower limbs)
#FLUID IN KNEE PAIN SKIN#
Skin changes (erythema marginatum/subcutaneous nodules) – seen rarely Heart murmur (mitral or aortic regurgitation)
Migratory polyarthritis/arthralgia – usually large joints Rash, conjunctivitis, cervical lymphadenopathy, swelling of hands and feet In a child who is limping or non-weight bearing without a swollen joint please see.History, examination, and tailored investigations will help to differentiate serious from benign causes.Joint swelling is a common feature in many conditions that affect children.Children discharged with an unclear diagnosis require early follow up.Septic arthritis is an orthopaedic emergency and should be suspected in any child presenting with localised severe joint pain and swelling, especially with fever.Acute inability to walk or weight bear is a red flag.The aim of initial assessment is to identify and treat serious ones There are many causes of an acutely swollen joint.Serum Sickness and Serum Sickness Like Reactions (SSLRs) Key points
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