Symptoms of Arthralgia
Symptoms of Arthralgia
The list of signs and symptoms mentioned in various sources
for Arthralgia includes the 7
symptoms listed below:
Research symptoms & diagnosis of Arthralgia:
Arthralgia Symptoms: Book Excerpts
- Signs and symptoms - Rheumatoid arthritis
- Signs and symptoms - Neurogenic arthropathy
- Signs and symptoms - Juvenile rheumatoid arthritis
- Signs and symptoms - Psoriatic arthritis
- Signs and symptoms - Septic arthritis
- Signs and symptoms - Rheumatoid arthritis
- Signs and symptoms - Neurogenic arthropathy
- Signs and symptoms - Juvenile rheumatoid arthritis
- Signs and symptoms - Psoriatic arthritis
- Signs and symptoms - Septic arthritis
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-1 2-Year-Old Boy
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-2 2-Year-Old Boy
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-3 14-Year-Old Boy
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-4 16-Year-Old Girl
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-5 13-Year-Old Boy
- IV. Clinical Presentation - Back, Joint, and Extremity Pain - Case 5-6 9-Year-Old Boy
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Other Possible Causes of these Symptoms
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Medical Books Online about Arthralgia
Medical Books Excerpts
Excerpts of published medical book chapters related to Arthralgia
are available from published medical books
for more detailed information about Arthralgia.
Medical Books Excerpts
- JOINT PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Arthralgia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Scrotal swelling
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Symptoms of Arthralgia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the symptoms of Arthralgia.
Rheumatoid arthritis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
RA usually develops insidiously and initially produces nonspecific signs and symptoms, such as fatigue, malaise, anorexia, persistent low-grade fever, weight loss, lymphadenopathy, and vague articular symptoms. Later, more specific localized articular symptoms develop, commonly in the fingers at the proximal interphalangeal, metacarpophalangeal, and metatarsophalangeal joints. These symptoms usually occur bilaterally and symmetrically and may extend to the wrists, knees, elbows, and ankles. The affected joints stiffen after inactivity, especially upon rising in the morning. The fingers may assume a spindle shape from marked edema and joint congestion. The joints become tender and painful, at first only when the patient moves them, but eventually even at rest. They commonly feel hot to the touch. Ultimately, joint function is diminished.
Deformities are common if active disease continues. (See Joint deformities.) Proximal interphalangeal joints may develop flexion deformities or become hyperextended. Metacarpophalangeal joints may swell dorsally, and volar subluxation and stretching of tendons may pull the fingers to the ulnar side (“ulnar drift”). The fingers may become fixed in a characteristic “swan’s neck” appearance, or “boutonnière” deformity. The hands appear foreshortened, the wrists boggy; carpal tunnel syndrome from synovial pressure on the median nerve causes tingling paresthesia in the fingers.
The most common extra-articular finding is the gradual appearance of rheumatoid nodules — subcutaneous, round or oval, nontender masses — usually on pressure areas such as the elbows. Vasculitis can lead to skin lesions, leg ulcers, and multiple systemic complications. Peripheral neuropathy may produce numbness or tingling in the feet or weakness and loss of sensation in the fingers. Stiff, weak, or painful muscles are common. Other common extra-articular effects include pericarditis, pulmonary nodules or fibrosis, pleuritis, scleritis, and episcleritis.
Another complication is destruction of the odontoid process, part of the second cervical vertebra. Rarely, cord compression may occur, particularly in patients with long-standing deforming disease. Upper motor neuron signs and symptoms, such as a positive Babinski’s sign and muscle weakness, may also develop.
RA can also cause temporomandibular joint disease, which impairs chewing and causes earaches. Other extra-articular findings may include infection, osteoporosis, myositis, cardiopulmonary lesions, lymphadenopathy, and peripheral neuritis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Neurogenic arthropathy:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Neurogenic arthropathy begins insidiously with swelling, warmth, decreased mobility, and instability in a single joint or in many joints. It can progress to deformity. The first clue to vertebral neuroarthropathy, which progresses to gross spinal deformity, may be nothing more than a mild, persistent backache. Characteristically, pain is minimal despite obvious deformity.
The specific joint affected varies according to the underlying cause. Diabetes usually attacks the joints and bones of the feet; tabes dorsalis attacks the large weight-bearing joints, such as the knee, hip, ankle, or lumbar and dorsal vertebrae (Charcot spine); syringomyelia causes occurrence in the shoulder, elbow, or cervical intervertebral joint. Neurogenic arthropathy caused by intra-articular injection of corticosteroids usually develops in the hip or knee joint.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Juvenile rheumatoid arthritis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Signs and symptoms vary with the type of JRA. Affecting males and females almost equally, systemic JRA accounts for approximately 10% to 30% of cases. The affected children may have mild, transient arthritis or frank polyarthritis associated with fever and rash. Joint involvement may not be evident at first, but the child’s behavior may clearly suggest joint pain. Such a child may constantly want to sit in a flexed position, may not walk much, or may refuse to walk at all. Young children with JRA are noticeably irritable and listless.
Fever in systemic JRA occurs suddenly and spikes to 103° F (39.4° C) or higher once or twice daily, usually in the late afternoon, then rapidly returns to normal or subnormal. (This “sawtooth” or intermittent spiking fever pattern helps differentiate JRA from other inflammatory disorders.) When fever spikes, an evanescent rheumatoid rash commonly appears, consisting of small pale or salmon pink macules, usually on the trunk and proximal extremities and occasionally on the face, palms, and soles. Massaging or applying heat intensifies this rash. It’s usually most conspicuous where the skin has been rubbed or subjected to pressure such as the areas of skin covered by underclothing.
Other signs and symptoms of systemic JRA may include hepatosplenomegaly, lymphadenopathy, pleuritis, pericarditis, myocarditis, and nonspecific abdominal pain.
Polyarticular JRA accounts for about 40% of cases and is three times more common in females than in males; affected children may be seronegative or seropositive for rheumatoid factor (RF). It involves five or more joints and usually develops insidiously. Most commonly involved joints are the wrists, elbows, knees, ankles, and small joints of the hands and feet. Polyarticular JRA can also affect larger joints, including the temporomandibular joints, cervical spine, hips, and shoulders. These joints become swollen, tender, and stiff. Usually, the arthritis is symmetrical; it may be remittent or indolent. The patient may run a low-grade fever with daily peaks. Listlessness and weight loss can occur, possibly with lymphadenopathy and hepatosplenomegaly. Other signs of polyarticular JRA include subcutaneous nodules on the elbows or heels and noticeable developmental retardation.
Seropositive polyarticular JRA, the more severe type, usually occurs late in childhood and can cause destructive arthritis that mimics adult rheumatoid arthritis.
Pauciarticular JRA involves few joints (usually no more than four), typically affecting the knees and other large joints. This form accounts for 45% of cases and has major subtypes. The first, pauciarticular JRA with chronic iridocyclitis, most commonly strikes females younger than age 6 and involves the knees, elbows, ankles, or iris. Inflammation of the iris and ciliary body is commonly asymptomatic but may produce pain, redness, blurred vision, and photophobia.
The second subtype, pauciarticular JRA with sacroiliitis, usually strikes males (9:1) older than age 8, who tend to test positive for human leukocyte antigen (HLA)-B27. This subtype is characterized by lower extremity arthritis that produces hip, sacroiliac, heel, and foot pain as well as Achilles' tendinitis. These patients may later develop the sacroiliac and lumbar arthritis characteristic of ankylosing spondylitis. Some also experience acute iritis, but not as many as those with the first subtype.
The third subtype includes patients with joint involvement who are antinuclear antibody (ANA) and HLA-B27 negative and don’t develop iritis. These patients have a better prognosis than those with the first or second subtype.
Common to all types of JRA is joint stiffness in the morning or after periods of inactivity. Back pain and limited range of motion is common. Growth disturbances may also occur, resulting in uneven length of arms or legs due to overgrowth or undergrowth adjacent to inflamed joints.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Psoriatic arthritis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Psoriatic lesions usually precede the arthritic component; however, after the full syndrome is established, joint and skin lesions recur simultaneously. Arthritis may involve one joint or several joints symmetrically. Spinal involvement occurs in some patients. Peripheral joint involvement is most common in the distal interphalangeal joints of the hands, which have a characteristic sausage-like appearance. Nail changes include pitting, transverse ridges, onycholysis, keratosis, yellowing, and destruction. The patient may experience general malaise, fever, and eye involvement.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Septic arthritis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Acute septic arthritis begins abruptly, causing intense pain, inflammation, and swelling of the affected joint and low-grade fever. It usually affects a single joint. It most commonly develops in the large joints but can strike any joint, including the spine and small peripheral joints. The hip is a frequent site in infants. Systemic signs of inflammation may not appear in some patients. Migratory polyarthritis sometimes precedes localization of the infection. If the bacteria invade the hip, pain may occur in the groin, upper thigh, or buttock or may be referred to the knee.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rheumatoid arthritis:
Signs and symptoms
(Handbook of Diseases)
RA usually develops insidiously and initially produces nonspecific signs and symptoms. These include fatigue, malaise, anorexia, persistent low-grade fever, weight loss, lymphadenopathy, and vague articular symptoms.
Specific symptoms
As the disease progresses, more specific localized articular symptoms develop, commonly in the fingers at the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and metatarsophalangeal joints. These symptoms usually occur bilaterally and symmetrically and may extend to the wrists, knees, elbows, and ankles.
The affected joints stiffen after inactivity, especially on rising in the morning. The fingers may assume a spindle shape from marked edema and congestion in the joints. The joints become tender and painful, at first only when the patient moves them, but eventually even at rest. They often feel hot to the touch. Ultimately, joint function is diminished. Deformities are common if active disease continues.
PIP joints may develop flexion deformities or become hyperextended. MCP joints may swell dorsally, and volar subluxation and stretching of tendons may pull the fingers to the ulnar side (“ulnar drift”).
The fingers may become fixed in a characteristic swan-neck or boutonnière deformity. The hands appear foreshortened and, the wrists boggy; carpal tunnel syndrome from synovial pressure on the median nerve causes paresthesia in the fingers.
CLINICAL TIP: Early intervention, under the guidance of an occupational therapist, with splinting and joint protection devices can effectively delay the progression of joint deformities.
Extra-articular signs
The most common extra-articular finding is the gradual appearance of rheumatoid nodules — subcutaneous, round or oval, nontender masses. These are seen in 20% of RA patients who are RF-positive. They usually appear on pressure areas, such as the elbows, hands, and Achilles tendon.
Vasculitis can lead to skin lesions, leg ulcers, and multiple systemic complications. Peripheral neuropathy may produce numbness or tingling in the feet or weakness and loss of sensation in the fingers. Stiff, weak, or painful muscles are common.
Other common extra-articular effects include pericarditis, pulmonary nodules or fibrosis, pleuritis, scleritis, and episcleritis.
Other complications
Another complication is destruction of the odontoid process, which is part of the second cervical vertebra. With C1 or C2 instability and subluxation, spinal cord compression may occur, particularly in patients with long-standing deforming RA. Upper-motor-neuron signs and symptoms, such as a positive Babinski’s sign and muscle weakness, may also develop.
RA can also cause temporomandibular joint disease, which impairs chewing and causes earaches. Other extra-articular findings include infection, osteoporosis, myositis, cardiopulmonary lesions, lymphadenopathy, and peripheral neuritis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Neurogenic arthropathy:
Signs and symptoms
(Handbook of Diseases)
Neurogenic arthropathy begins insidiously with swelling, warmth, increased mobility, and instability in a single joint or in many joints. It can progress to deformity. The first clue to vertebral neuroarthropathy, which progresses to gross spinal deformity, may be nothing more than a mild, persistent backache. Characteristically, pain is minimal despite obvious deformity.
The specific joint that’s affected varies. Diabetes usually attacks the joints and bones of the feet; tabes dorsalis attacks the large weight-bearing joints, such as the knee, hip, ankle, or lumbar and dorsal vertebrae (Charcot spine); syringomyelia, the shoulder, elbow, or cervical intervertebral joint. Neurogenic arthropathy related to intra-articular injection of a corticosteroid usually develops in the hip or knee joint.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Juvenile rheumatoid arthritis:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms vary with the type of JRA.
Systemic JRA
Affecting boys and girls almost equally, systemic JRA accounts for 20% to 30% of cases. Affected children may have mild, transient arthritis or frank poly-arthritis associated with fever and rash.
CLINICAL TIP: Joint involvement may not be evident at first, but the child’s behavior may clearly suggest joint pain. Such a child may want to constantly sit in a flexed position, may not walk much, or may refuse to walk at all. Young children with JRA are noticeably irritable and listless.
Fever in systemic JRA occurs suddenly and spikes to 103° F (39.4° C) or higher once or twice daily, usually in the late afternoon, then rapidly returns to normal or subnormal. (This sawtooth, or intermittent spiking, fever pattern helps differentiate JRA from other inflammatory disorders.) When fever spikes, an evanescent rheumatoid rash typically appears, consisting of small, pale or salmon pink macules, most commonly on the trunk and proximal extremities and occasionally on the face, palms, and soles.
Massaging or applying heat intensifies this rash, which is usually most conspicuous where the skin has been rubbed or subjected to pressure, such as that from underclothing.
Other signs and symptoms of systemic JRA include hepatosplenomegaly, lymphadenopathy, pleuritis, pericarditis, myocarditis, and nonspecific abdominal pain.
Polyarticular JRA
Polyarticular JRA is four to nine times more common in girls than in boys and may be seronegative or seropositive for rheumatoid factor (RF). It involves five or more joints and usually develops insidiously. The joints most commonly involved are the wrists, elbows, knees, ankles, and small joints of the hands and feet.
Polyarticular JRA can also affect larger joints, including the temporomandibular joints and those of the cervical spine, hips, and shoulders. These joints become swollen, tender, and stiff.
Usually, the arthritis is symmetrical; it may be remittent or indolent. The patient may run a low-grade fever with daily peaks. Listlessness and weight loss can occur, possibly with lymphaden-opathy and hepatosplenomegaly. Other signs of polyarticular JRA include subcutaneous nodules on the elbows or heels and noticeable developmental retardation.
Seropositive polyarticular JRA, the more severe type, usually occurs late in childhood and can cause destructive arthritis that mimics adult RA.
Pauciarticular JRA
Involving few joints (usually no more than four), pauciarticular JRA usually affects the knees and other large joints. It accounts for 45% of cases. Three major subtypes exist:
❑ Pauciarticular JRA with chronic iridocyclitis most commonly affects girls younger than age 6 and involves the knees, elbows, ankles, or iris. Inflammation of the iris and ciliary body is typically asymptomatic, but may produce pain, redness, blurred vision, and photophobia. Young girls who test positive for antinuclear antibodies (ANAs) are at highest risk for eye complications.
❑ Pauciarticular JRA with sacroiliitis usually affects boys (9:1) older than age 8, who tend to be human leukocyte antigen (HLA)-B27–positive. This subtype is characterized by lower-extremity arthritis that produces hip, sacroiliac, heel, and foot pain and Achilles tendinitis. These patients may later develop the sacroiliac and lumbar arthritis characteristic of ankylosing spondylitis. Some patients also experience acute iritis, but not as many as those with the first subtype.
❑ The third subtype includes patients with joint involvement who test negative for ANAs and HLA-B27 and who don’t develop iritis. Characterized by asymmetrical involvement of large or small joints, this subtype can strike at any age during childhood. These patients have a better prognosis than those with the first or second subtype, although some may progress to polyarticular disease.
Common to all types of JRA is joint stiffness in the morning or after periods of inactivity. Growth disturbances may also occur, resulting in overgrowth or undergrowth adjacent to inflamed joints.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Psoriatic arthritis:
Signs and symptoms
(Handbook of Diseases)
Psoriatic lesions usually precede the arthritic component; however, when the full syndrome is established, joint and skin lesions may recur simultaneously. Arthritis may involve one joint or several joints asymmetrically or symmetrically. Spinal involvement occurs in some patients. Peripheral joint involvement is most common in the distal interphalangeal joints of the hands, which have a characteristic sausage-like appearance. Nail changes include pitting, transverse ridges, onycholysis, keratosis, yellowing, and destruction. The patient may experience general malaise, fever, and eye involvement.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Septic arthritis:
Signs and symptoms
(Handbook of Diseases)
Acute septic arthritis begins abruptly, causing intense pain, inflammation, and swelling of the affected joint, with low-grade fever. Although it usually affects a single, large joint, it can affect any joint, including the spine and small peripheral joints.
CLINICAL TIP: Systemic signs of inflammation may not appear in some patients. Migratory polyarthritis sometimes precedes localization of the infection. If the bacteria invade the hip, pain may occur in the groin, upper thigh, or buttock, or may be referred to the knee.
UNDER STUDY: The tumor necrosis factor (TNF) 2 allele has been associated with higher septic shock susceptibility and mortality. Investigation of polymorphisms within the TNF alpha cluster will be important in understanding the role of TNF alpha regulation in specific diseases.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Back, Joint, and Extremity Pain - Case 5-1: 2-Year-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Most children develop fever early during the course of infection. Common
presenting complaints include back pain, limp, and refusal to walk. Hip pain is
an unusual presenting complaint, although it may be difficult to differentiate
back from hip pain in an ill and irritable child. Depending on the level of
involvement, progression of infection can cause spinal cord compression, muscle
weakness, and bowel and bladder incontinence followed by paralysis. On
examination, there may be tenderness over the vertebrae or paraspinal tissues.
Some children develop protective paraspinal muscle spasm. There may also be
loss of normal curvature of the spine (usually decreased lumbar lordosis) and
limited lumbosacral mobility. Abdominal pain is relatively common and can
indicate radicular pain or associated psoas abscess.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Back, Joint, and Extremity Pain - Case 5-2: 2-Year-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
The presenting symptoms and signs of children with ALL reflect the degree of
bone marrow infiltration with leukemic cells and the extent of extramedullary
disease spread. Symptoms may be present for days or months and include fever,
anorexia, fatigue, and pallor. Bone pain occurs with leukemic involvement of
the periosteum and bone. Young children often develop a limp or refuse to walk.
Headache, vomiting, and seizures suggest CNS involvement. Rarely, children
present with oliguria due to acute renal failure precipitated by hyperuricemia.
On examination, painless lymphadenopathy (50%) and hepatosplenomegaly (68%)
result from extramedullary spread of the disease. Petechiae and purpura are
more common, but some children also have subconjunctival and retinal
hemorrhages. Children may have focal bone tenderness. Testicular enlargement
due to leukemic infiltration is present in 5% of boys with ALL.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Back, Joint, and Extremity Pain - Case 5-3: 14-Year-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Several studies have documented considerable delays in the diagnosis of SCFE.
Patients frequently complain of symptoms for 3 to 4 months before the diagnosis
is made. Therefore, clinicians should have a high level of suspicion for the
diagnosis of SCFE even in adolescents with vague complaints of hip, thigh, or
knee pain.
Patients with SCFE usually complain of pain in the affected hip or groin. Pain
perceived in the medial thigh and knee is caused by referred hip pain along the
sensory distribution of the femoral and obturator nerves. Isolated knee pain is
the sole presenting feature in up to 15% of children diagnosed with SCFE. Early
in the course, pain is usually associated with exercise, but as the slip
progresses, the symptoms become more persistent and severe.
On physical examination, patients complain of pain with rotation of the hip. The
pain is most prominent at the extremes of rotation. Internal rotation may be
noticeably decreased. Furthermore, as the hip is flexed, the thigh rotates
externally. This finding, when present, is almost pathognomonic for SCFE in an
obese adolescent. Thigh or gluteal muscle atrophy occurs with long-standing
symptoms and disuse.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Back, Joint, and Extremity Pain - Case 5-4: 16-Year-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Approximately 80% of children with Crohn's disease present with abdominal pain, diarrhea, anorexia, and weight loss with
or without extraintestinal manifestations. Recurrent oral ulcers are common.
Abdominal pain in the right lower quadrant suggests ileocecal involvement,
epigastric pain suggests gastroduodenal involvement, and periumbilical pain
suggests generalized small-bowel disease. Fifty percent of children have gross
or microscopic blood in the stool. Perirectal disease (e.g., fissures,
fistulas, skin tags, abscesses) are present in up to 40% of patients.
Extraintestinal manifestations predominate in 8% to 10% of patients and are
likely to be associated with diagnostic confusion and delay (Table 5-3).
Although more than 100 localized extraintestinal manifestations have been
described, the most common are joint complaints (including arthritis), which
occur in 15% to 30% of cases. Approximately 50% of children with Crohn
's disease and peripheral arthritis develop ocular or skin findings (see Table
5-3). Sclerosing cholangitis develops in 1% of children with Crohn
's disease. Symptoms of sclerosing cholangitis include jaundice, generalized
pruritus, and abdominal pain. Pancreatitis occurs as an extraintestinal
manifestation of Crohn
's disease but can also occur as a complication of duodenal involvement,
sclerosing cholangitis, or drug therapy. Renal stones complicating Crohn
's disease may be due to calcium oxalate, calcium phosphate, or uric acid.
Erythema nodosum tends to occur when intestinal disease is active, but it does
not correlate with disease severity. Rashes due to trace mineral deficiencies
may occur as a consequence of malabsorption.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Back, Joint, and Extremity Pain - Case 5-5: 13-Year-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Universal screening for SCD has been widely available in most states in the
United States since 1986, and most children with SCD are diagnosed as newborns.
A few infants, even in states with universal screening, may not be screened; in
others, the diagnosis may be missed because of extreme prematurity, blood
transfusions before screening, or inadequate follow-up after discharge. In some
patients with Sbeta
+, the levels of HbA are high enough to impair polymerization of HbS and reduce
intravascular sickling of the RBCs. The early clinical course in these patients
is mild, with significant symptoms appearing later in life.
Acute and chronic complications of SCD involve multiple organ systems (Table
5-5). Bones and joints are major sites of pain in vaso-occlusive events. Acute
bone pain is caused by marrow ischemia, which results in necrosis and
inflammation. Pain is widespread and migratory during the acute painful crisis.
Local tenderness, warmth, swelling, and impaired motion occur with a severe
pain episode as the generalized pain improves. As seen in this patient,
vertebral infarction may lead to collapse of the end-plates, known as
“fish-mouth” vertebrae. No single clinical feature can reliably distinguish osteomyelitis
from bone infarction. Acute painful events are the most common cause of
emergency department visits and hospitalizations among patients with SCD. These
events may be precipitated by weather extremes or temperature changes,
dehydration, infection, stress, or menstruation; however, the majority of
painful events have no identifiable trigger. Painful episodes vary from mild to
debilitating. Pain is usually self-limited, lasting from a few hours to a few
days, although inadequate treatment may prolong the episode for weeks.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Back, Joint, and Extremity Pain - Case 5-6: 9-Year-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Acute rheumatic fever is a nonsuppurative sequela of GABHS pharyngitis. The
symptoms begin approximately 1 to 3 weeks after the throat infection, but in
many cases a sore throat is not reported, even in retrospect. GABHS infections
that do not include pharyngitis are not initiators of ARF.
Approximately 80% of patients present with arthritis, and it typically is a
migratory polyarthritis with predilection for large joints. In contrast to Lyme
arthritis, the subjective pain of ARF arthritis often is much more severe than
the objective findings visible to the examiner. Analysis of fluid from an
acutely inflamed joint reveals an elevated WBC count in the range of 20,000 to
40,000 cells/mm
3 with a neutrophil predominance.
Carditis can involve any part of the heart but most typically is an endocardial
process with particular affinity for the mitral and aortic valves. Acutely the
valves demonstrate insufficiency, but the lesions progress to stenosis over
time. Involvement of the myocardium can be seen especially with the more severe
presentations of congestive heart failure. Pericarditis and epicarditis can
also complicate the picture, but they rarely occur in isolation. Carditis
develops in approximately half of patients, but it has been reported in up to
80% of patients in the more recent U. S. outbreaks. Clinical signs accepted for
evidence of carditis include appropriate murmurs, cardiomegaly, congestive
heart failure, or pericardial friction rub. The most recent update of the Jones
criteria (1992) did not consider echocardiographic evidence of valvulitis
without auscultatory findings to be sufficient to establish the presence of
carditis for ARF.
Erythema marginatum and subcutaneous nodules are seen infrequently. When
erythema marginatum is fully developed, it has an indistinct serpiginous red
border with central clearing and is nonpruritic. It is specific for ARF, but
its usefulness is limited by the fact that the rash is evanescent and is
present in fewer than 10% of patients. Subcutaneous nodules are usually a late
finding of ARF and may correlate with more severe or prolonged carditis. The
lesions are pea-sized and nontender, and they tend to be located over extensor
tendons at the elbows, knees, or Achilles.
Sydenham's chorea is a late manifestation of ARF; it can manifest after resolution of the
other features, or in isolation if the other features were never clinically
apparent. This movement disorder may start with subtle deteriorations of
handwriting before evolving into the involuntary, uncontrollable, and
purposeless choreiform movements. Due to the late onset of this feature, the
presence of Sydenham
's alone can be considered diagnostic of ARF if other causes of chorea have been
excluded.
Some of the minor criteria for ARF in some ways overlap with major criteria.
Arthralgias, painful joints without objective findings of arthritis, should be
considered only if arthritis is not used as a major criterion. However, PR
prolongation by ECG can be considered in addition to ausculatory evidence of
carditis. The ESR and CRP are significantly elevated with the acute illness,
with the ESR usually greater than 50 mm/hour and often approaching or exceeding
100 mm/hour. The fever has no characteristic pattern; it usually resolves
within 3 weeks, even without treatment.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Arthralgia as a symptom:
For a more detailed analysis of Arthralgia as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Arthralgia.
Medical articles and books on symptoms:
These general reference articles may be of interest
in relation to medical signs and symptoms of disease in general:
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Arthralgia:
The symptom information on this page
attempts to provide a list of some possible signs and symptoms of Arthralgia.
This signs and symptoms information for Arthralgia has been gathered from various sources,
may not be fully accurate,
and may not be the full list of Arthralgia signs or Arthralgia symptoms.
Furthermore, signs and symptoms of Arthralgia may vary on an individual basis for each patient.
Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they
are indeed Arthralgia symptoms.
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
Conventional medical treatments for arthritis have come a long way in recent years. But many people suffering from arthritis pain have found...
In this segment, Dr. Allan Gibofsky answers viewer you questions about arthritis. Is there a connection between arthritis and fibromyalgia?
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