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When to seek advice

'PMMALERTS' help identify significant problems & when to seek advice

Additional notes
Painful joints
Poor school attendance
A flare of arthritis may result in joints being more painful or stiff.
An infected joint may be also red and hot; the child is likely to be unwell.
Time off school may indicate severity of problem.
A fever may indicate a flare of disease or intercurrent infection or complication of treatment. Be aware of patients who are immunosuppressed as fever may be mild or absent despite serious illness.
Movement restricted
Mobility problems
Mechanical pain
Often children compensate for mobility problems. Observing children at play often highlights problems.
Many children are hypermobile which may explain pain; note that children with hypermobility may also develop more serious conditions e.g., JIA or leukaemia.
Muscle weakness
Muscle pain
Muscle wasting
It might be noticed at school or home, that children find it difficult to stand up after sitting on the floor.
Appetite changes
Altered balance
Children with an untreated chronic illness may have reduced appetite, poor weight gain or weight loss.
Parents might comment that their child is clumsy.
Leg length discrepancy
Laxity of joints
Limping might be due to joint pain or other causes.
Leg length discrepancy can occur with untreated active arthritis in the knee or due to hip disease.
Children are more flexible than adults. Hypermobility is a normal feature in children and sometimes can associate with pain.
Early morning stiffness
Eye problems
Child may struggle getting out of bed due to joint stiffness (such as in JIA).
Blurring, floaters can occur with eye inflammation (uveitis) which occurs commonly in JIA. Red eyes or pain are less common with uveitis in JIA and may indicate infection.
Restriction of joints
Rashes are common in many rheumatological conditions - Butterfly rash on cheeks (Lupus), Blotchy, salmon pink rash on trunk, arms and legs (Systemic JIA), Purplish scaly rash on knuckles, elbows, eyelids (Dermatomyositis).
Joint pathology can result in stiff joints.
Tiredness and fatigue
Recurrent fever pattern occurs in many rheumatic conditions (eg active systemic JIA) and often occurs in the evenings and with a rash.
Caused by chronic active inflammation (joints, muscles or systemic disease).
Swollen joints
Stiff joints 
Skin Elasticity
Sleep disturbance
Joints can appear swollen and can be more obvious if the changes are compared to same joint other side of the body e.g., knee or finger joints.
The skin can be more elastic and prone to bruising or scarring in some hypermobility syndromes. Skin can be less elastic in scleroderma.
Recurrent night time waking can indicate red flag conditions and warrants concern.

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