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.
| 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. |
