Differential Diagnosis for Chronic Pain and Inability to Walk in Children

Single Most Likely Diagnosis

• Juvenile Idiopathic Arthritis (JIA): This is a common cause of chronic pain and mobility issues in children, characterized by joint inflammation and stiffness. The age range of the children (8 and 17) fits within the typical onset age for JIA, and the symptoms of chronic pain and inability to walk at times align with the disease's manifestations.

Other Likely Diagnoses

• Growing Pains: Although more common in younger children, growing pains can still be a consideration in an 8-year-old, characterized by recurrent leg pain, typically in the evenings.
• Fibromyalgia: Though less common in children, fibromyalgia can cause widespread musculoskeletal pain, fatigue, and sleep issues, which might lead to difficulties in walking due to pain.
• Complex Regional Pain Syndrome (CRPS): This condition is characterized by intense burning or aching pain in the hands or feet after an injury, which could potentially lead to mobility issues if the pain is severe enough.

Do Not Miss Diagnoses

• Cancer (e.g., Leukemia, Bone Tumors): Although rare, cancers such as leukemia or bone tumors can present with chronic pain and mobility issues due to bone involvement. Missing these diagnoses could be fatal.
• Infections (e.g., Osteomyelitis, Septic Arthritis): Infections of the bone or joints can cause severe pain and limit mobility. Prompt diagnosis and treatment are crucial to prevent long-term damage.
• Neurological Conditions (e.g., Multiple Sclerosis, Guillain-Barré Syndrome): Certain neurological conditions can cause pain and significant mobility issues. Early diagnosis is critical for effective management.

Rare Diagnoses

• Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Some types can lead to chronic pain and joint instability.
• Sickle Cell Disease: A genetic disorder that affects hemoglobin production, leading to abnormal red blood cells. It can cause episodes of pain (sickle cell crises) that might affect mobility.
• Chronic Recurrent Multifocal Osteomyelitis (CRMO): A rare condition characterized by recurring episodes of bone inflammation, which can cause chronic pain and mobility issues.