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Assessing Joint Symptoms

 A careful assessment can distinguish between mechanical and inflammatory causes of joint pain. This can be difficult however. Where there is doubt, symptoms persist or the child is unwell, then discussion with the specialist rheumatology team is recommended

Knowledge of terms used to describe symptoms (e.g arthritis, arthralgia, mylagia) and which joints are affected is useful. This is particularly helpful when communicating with health care professionals (e.g telephone advice). 

 
Inflammatory joint disease 
Mechanical joint disease 
Muscle disease 
Pain
Yes, but may not be verbally expressed, particularly in younger children (below 4 years). May manifest as change of mood, tiredness or avoidance of activities. Worse after periods of rest and gets better with exercise.
Usually a predominant feature - worse on exercise.              
 
Movement in relationship to activity
Movement may ease symptoms; inactivity may cause gelling/stiffness of the joint.
Usually worse with and after activity.
Reduced endurance. May complain of pain in legs after activity.
Morning stiffness
Present. Important to ask about dressing, behaviour and activities in the mornings. Stiffness may manifest as 'gelling' after periods of rest (e.g. difficulty getting up from sitting on the floor or climbing down the stairs).
Usually absent. 
Absent.
Swelling
Yes and usually persistent.
Usually transient.
Calf hypertrophy (overdeveloped calf muscles, out of proportion with rest of body).
Locking
Usually absent.
May be present.
Absent
Giving way
Usually absent.
May be present. 
May be present.
Worst time of day
Usually mornings.
Often after school or evening.
Mornings can be worse after activity.
Restriction of movement
Often present, can be intense.
May be present.
May have limb tightness.

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