AB0991 EPIDEMIOLOGY AND CLINICAL FEATURES OF CHRONIC JOINT PAIN IN CHILDREN AND ADOLESCENTS
Authors: A. Kozhevnikov, N. Pozdeeva, M. Nikitin, Y. Proshchenko, G. Novik
Journal: Annals of the Rheumatic Diseases (2020)

Background: Arthralgia in children for many years continues to maintain the status of the most common symptom of rheumatic diseases. However this symptom should not always be interpreted as a manifestation of arthritis. Well known that arthralgia in growing children is a frequent problem which can be caused by pathological or innocuous process. Objectives: The goal of this study was to analyze the structure of childhood arthralgia. Methods: We carried out a retrospective review of 600 children who applied to the outpatient department of the institute with a complaint of pain lasting longer than two months in one or more joints. The clinical, instrumental and laboratory pictures were studied. Special attention was paid to certain aspect of joint pain by the child or his parents. The data obtained made it possible to systematize and detail the nature of the articular pathology in children of various age groups. Results: All children were divided into several groups based on their anatomical and physiological characteristics of osteoarticular system: the first group consisted of 240 children under 6-7 years old, the second group – 220 children 7-12 years old, the third group – 140 children over 12 years old. Research suggests that more preschool children were experience bilateral lower extremity pain by “post-walk genesis” due to natural hypermobility, immaturity of sensory innervation of the joints and imbalance of the leg muscles (e.g. growing pains). The second most common cause was joints pain associated with infectious factor (post-infectious genesis or chronic foci of infection). The frequency of juvenile arthritis and other rheumatic diseases in children of this age group did not exceed 10%. Special attention was paid to nightpain with fever and changes in blood tests to exclude malignancies manifestation and other tumors (less 5%). The most common causes of joint pain of school-age children were hypermobility syndrome and enthesopathy (primary, secondary). Secondary enthesopathy were result of changes in nutrition, rapid growth and excessive exercise. Also enthesopathy were manifestation of endocrine, gastrointestinal or infectious diseases. The proportion of children with the onset of chronic inflammatory arthropathy also did not exceed 10%. Hypermobility child’s syndrome was characterized by harmless pain, linked to physical activity (less morning stiffness). Over the past decade, we’ve seen a gradual increase in the number of children with diagnosed patellofemoral pain (non-traumatic) and mediopatellar plica syndromes (95% were girls). In most cases children was complicated by syndrome of increased anxiety. Cases of apophysitis as cause of chronic arthralgia were over 15%. The share of true chronic inflammatory arthropathies, including spondylitis, in children of this age group did not exceed 10%. Fibromyalgia were diagnosed less 5%. Conclusion: Despite continuous improvements in examination technique and image quality there is no universal test to diagnose cause of childhood arthralgia. Age features, individual nature of pain perception, the high frequency of incomplete and transient forms of arthropathy, cases atypical joint diseases have been intriguing problems for diagnostic pathology. Integrated assessment modelling framework of the clinical and instrumental pictures with understanding of the anatomical and physiological characteristics of childhood will help identify the true cause of chronic musculoskeletal pain. there is no single test to diagnose CA Disclosure of Interests: None declared