Top Tips for Swollen Joint(s)

There are many causes of musculoskeletal pain. The diagnosis rests on careful clinical assessment and interpretation of investigations

If a child presents with a single swollen joint then it is important all joints are examined (using pGALS) as the history alone may not always identify affected joints; observing the child playing may help identify the site of joint problems

In the UK the most common cause for a swollen joint in the absence of trauma or infection is Juvenile Idiopathic Arthritis (JIA).

In the context of a single swollen joint, infection (and sometimes malignancy) must always be considered and needs to include the possibility of mycobacterial disease in at risk groups.

In the context of multiple swollen joints, there is a wide spectrum of causes including inflammatory, reactive, multisystem disease, metabolic causes and malignancy.

In hypermobility, joint swelling can be often transient (lasting hours or a few days at the most) after activity; such swelling will be mild and resolve spontaneously. If persistent swelling (lasting more than a week) or if the child is unwell, then medical assessment is needed to rule out other causes.

Children with JIA are at risk of blindness from chronic anterior uveitis, if it is not detected and treated. Uveitis can develop without symptoms of a red eye, pain or blurring, in the early stages. Eye screening is important to detect the uveitis and needs to continue often on a regular basis for several years. If detected early, then most children do well and sight is not affected.

Swollen joints in JIA are often stiff in the morning and result in loss of function (difficulties in walking, play or school work). Symptoms may be worse after inactivity and may improve during the day.

The use of non-steroidal anti-inflammatories are useful to reduce joint stiffness and pain but do not prevent joint damage.

Rest, ice, compression and elevation (RICE) can be useful to ease symptoms of a swollen joint irrespective of the cause.