http://www.ped-rheum.com The most accessed research articles published by Pediatric Rheumatology 2010-02-11T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. http://www.ped-rheum.com/content/5/1/5 Yosef Uziel Philip Hashkes Pediatric Rheumatology 2007, 5:5 2007-04-19T00:00:00Z doi:10.1186/1546-0096-5-5 Pediatric Rheumatology 1546-0096 5 5 2007-04-19T00:00:00Z XML ObjectivesTo examine the prescribing habits of NSAIDs among pediatric medical and surgical practitioners, and to examine concerns and barriers to their use. Methods: A sample of 1289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons and pediatric orthopedic surgeons in the United States and Canada were sent an email link to a 22-question web-based survey. Results: 338 surveys (28%) were completed, 84 were undeliverable. Of all respondents, 164 (50%) had never prescribed a selective cyclooxygenase-2 (COX-2) NSAID. The most common reasons for ever prescribing an NSAID were musculoskeletal pain, soft-tissue injury, fever, arthritis, fracture, and headache. Compared to traditional NSAIDs, selective COX-2 NSAIDs were believed to be as safe (42%) or safer (24%); have equal (52%) to greater efficacy (20%) for pain; have equal (59%) to greater efficacy (15%) for inflammation; and have equal (39%) to improved (44%) tolerability. Pediatric rheumatologists reported significantly more frequent abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%) and fatigue (12% vs. 1%) for traditional NSAIDs than for selective COX-2 NSAIDs. Prescribing habits of NSAIDs have changed since the voluntary withdrawal of rofecoxib and valdecoxib; 3% of pediatric rheumatologists reported giving fewer traditional NSAID prescriptions, and while 57% reported giving fewer selective COX-2 NSAIDs, 26% reported that they no longer prescribed these medications. Conclusions: Traditional and selective COX-2 NSAIDs were perceived as safe by pediatric specialists. The data were compared to the published pediatric safety literature. http://www.ped-rheum.com/content/8/1/7 Deborah Levy Lisa Imundo Pediatric Rheumatology 2010, 8:7 2010-02-04T00:00:00Z doi:10.1186/1546-0096-8-7 Pediatric Rheumatology 1546-0096 8 7 2010-02-04T00:00:00Z XML Background: In this study we aimed to identify and review publications relating to the diagnosis of joint hypermobility and instability and develop an evidence based approach to the diagnosis of children presenting with joint hypermobility and related symptoms. Methods: We searched Medline for papers with an emphasis on the diagnosis of joint hypermobility, including Heritable Disorders of Connective Tissue (HDCT). Results: 3330 papers were identified: 1534 pertained to instability of a particular joint; 1666 related to the diagnosis of Ehlers Danlos syndromes and 330 related to joint hypermobility.There are inconsistencies in the literature on joint hypermobility and how it relates to and overlaps with milder forms of HDCT. There is no reliable method of differentiating between Joint Hypermobility Syndrome, familial articular hypermobility and Ehlers-Danlos syndrome (hypermobile type), suggesting these three disorders may be different manifestations of the same spectrum of disorders. We describe our approach to children presenting with joint hypermobility and the published evidence and expert opinion on which this is based. Conclusion: There is value in identifying both the underlying genetic cause of joint hypermobility in an individual child and those hypermobile children who have symptoms such as pain and fatigue and might benefit from multidisciplinary rehabilitation management.Every effort should be made to diagnose the underlying disorder responsible for joint hypermobility which may only become apparent over time. We recommend that the term "Joint Hypermobility Syndrome" is used for children with symptomatic joint hypermobility resulting from any underlying HDCT and that these children are best described using both the term Joint Hypermobility Syndrome and their HDCT diagnosis. http://www.ped-rheum.com/content/7/1/1 Louise Tofts Elizabeth Elliott Craig Munns Verity Pacey David Sillence Pediatric Rheumatology 2009, 7:1 2009-01-05T00:00:00Z doi:10.1186/1546-0096-7-1 Pediatric Rheumatology 1546-0096 7 1 2009-01-05T00:00:00Z XML We report on pediatric patient with clinical and laboratory evidence of pancreatitis at onset of atypical Kawasaki disease (KD). In KD pancreatic inflammation was described previously, but clinical pancreatitis was rarely reported and its true incidence is unknown.In febrile pediatric patients suspected to have KD, but not fulfilling classical diagnostic criteria, signs of pancreatic inflammation may help in making correct diagnosis. Further analysis of cases with atypical KD developing pancreatitis may reveal if signs of pancreatic inflammation can be used as supportive diagnostic finding. http://www.ped-rheum.com/content/8/1/8 Dragan Prokic Goran Ristic Zoran Paunovic Srdjan Pasic Pediatric Rheumatology 2010, 8:8 2010-02-11T00:00:00Z doi:10.1186/1546-0096-8-8 Pediatric Rheumatology 1546-0096 8 8 2010-02-11T00:00:00Z XML Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population. http://www.ped-rheum.com/content/7/1/10 Kristin Houghton Pediatric Rheumatology 2009, 7:10 2009-05-18T00:00:00Z doi:10.1186/1546-0096-7-10 Pediatric Rheumatology 1546-0096 7 10 2009-05-18T00:00:00Z XML Anterior knee pain is common in children and adolescents. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of chronic anterior knee pain in the pediatric population with a focus on patellofemoral pain. http://www.ped-rheum.com/content/5/1/8 Kristin Houghton Pediatric Rheumatology 2007, 5:8 2007-05-04T00:00:00Z doi:10.1186/1546-0096-5-8 Pediatric Rheumatology 1546-0096 5 8 2007-05-04T00:00:00Z XML Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population. http://www.ped-rheum.com/content/6/1/6 Kristin Houghton Pediatric Rheumatology 2008, 6:6 2008-04-09T00:00:00Z doi:10.1186/1546-0096-6-6 Pediatric Rheumatology 1546-0096 6 6 2008-04-09T00:00:00Z XML We report a 14-year-old girl with juvenile dermatomyositis (JDM) complicated by severe inflammatory calcinosis successfully treated with thalidomide. She was diagnosed as JDM when she was 4 years old after a few months of increasing lethargy, muscle pain, muscle weakness, and rash. During three months, clinical manifestations and abnormal laboratory findings were effectively treated with oral prednisolone. However, calcinosis was recognized 18 months after disease onset. Generalized calcinosis rapidly progressed with high fever, multiple skin/subcutaneous inflammatory lesions, and increased level of CRP. Fifty mg/day (1.3 mg/kg day) of oral thalidomide was given for the first four weeks, and then the dose was increased to 75 mg/day. Clinical manifestations subsided, and inflammatory markers had clearly improved. Frequent high fever and local severe pain with calcinosis were suppressed. The levels of FDP-E, IgG, and tryglyceride, which were all elevated before the thalidomide treatment, were gradually returned to the normal range. Over the 18 months of observation up to the present, she has had no inflammatory calcinosis, or needed any hospitalization, although established calcium deposits still remain. Her condition became painless, less extensive and less inflammatory with the CRP level below 3.08 mg/dL. Recent examination by whole-body 18F-FDG-PET-CT over the 15 months of thalidomide treatment demonstrated fewer hot spots around the subcutaneous calcified lesions. http://www.ped-rheum.com/content/8/1/6 Takako Miyamae Fumie Sano Remi Ozawa Tomoyuki Imagawa Yoshiaki Inayama Shumpei Yokota Pediatric Rheumatology 2010, 8:6 2010-02-04T00:00:00Z doi:10.1186/1546-0096-8-6 Pediatric Rheumatology 1546-0096 8 6 2010-02-04T00:00:00Z XML A 12-year-old girl developed influenza B virus infection proven by typical symptoms and detection of the virus in a nasopharyngeal swab by culture and PCR. Two weeks later she developed an otherwise unexplained transient oligoarthritis of small joints of the left foot. Influenza viruses may be a hitherto underappreciated cause of a post-infectious arthritis. http://www.ped-rheum.com/content/8/1/4 Normi Bruck Manfred Gahr Frank Pessler Pediatric Rheumatology 2010, 8:4 2010-01-14T00:00:00Z doi:10.1186/1546-0096-8-4 Pediatric Rheumatology 1546-0096 8 4 2010-01-14T00:00:00Z XML It is increasingly recognized that osteoporosis affects children as well as adults both as a primary problem and as secondary to various diseases, medications, and lifestyle issues. In this review, we emphasize the correct diagnosis of osteoporosis in children as opposed to adults, etiology, and pharmaceutical and non-pharmaceutical treatments. We especially focus on rheumatologic conditions associated with osteoporosis and management issues. http://www.ped-rheum.com/content/7/1/16 Yosef Uziel Eyal Zifman Philip Hashkes Pediatric Rheumatology 2009, 7:16 2009-10-16T00:00:00Z doi:10.1186/1546-0096-7-16 Pediatric Rheumatology 1546-0096 7 16 2009-10-16T00:00:00Z XML