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Multi-system Disease

Many acute and chronic conditions in paediatrics involve joint, muscle or bone pain.

Infections:  the list below is not comprehensive but highlights that within all areas of paediatrics there are chronic conditions that can develop musculoskeletal features including arthritis. 

  • Cardiology: Kawasaki disease, Rheumatic Fever.
  • Respiratory: Cystic Fibrosis.
  • Gastroenterology: Inflammatory Bowel Disease, Coeliac disease.
  • Renal disease: Henoch Schönlein Purpura.
  • Neurology: Inherited myopathies, Inflammatory myopathies.
  • Metabolic / Endocrine / Nutritional:  Osteomalacia (Rickets), Hypothyroidism, Mucopolysaccharidoses, Scurvy.
  • Immunology: Immunodeficiency, Autoinflammatory.
  • Haematology: Sickle cell anaemia, Haemophilia. 
  • Chromosomal and Genetics: Downs syndrome, Skeletal Dysplasias.
  • Infections: e.g., Human Immunodeficiency Virus, Tuberculosis, Brucellosis, Lyme disease, Arbovirus borne infections, Reactive Arthritis.

This module covers many of these conditions within the sub-modules of single joint and multiple joint arthritis, Juvenile Idiopathic Arthritis, Multisystem disease (including infections, connective tissue diseases, autoinflammatory diseases and genetic conditions).

More information about septic arthritis and osteomyelitis is given in the Clinical Assessment, Investigations and Limping child modules.

Musculoskeletal features are common in inflammatory multisystem disease: this can be true arthritis (usually affecting many joints in a symmetrical pattern) or arthralgia (painful joints without overt swelling) with or without myalgia (muscle pain) or myositis (muscle pain and tenderness, often with weakness).

Systemic features may be present - malaise, fatigue, weight loss, fever, rash - and may relate to a connective tissue disease such as Juvenile Systemic Lupus Erythematosus, Juvenile Dermatomyositis, Vasculitis, Scleroderma, Periodic (Autoinflammatory) syndromes although the differential diagnosis includes red flag conditions such as infection, rheumatic fever and malignancy

Diagnosis rests on clinical assessment and careful use and interpretation of investigations. 

We include cases to highlight approaches to the differential diagnosis. 

The photograph below shows skin vasculitis



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