Differential Diagnosis for Multiple Joint Pain and Swelling in a 7-year-old
- The following differential diagnosis is organized into categories to guide further investigation and management.
Single most likely diagnosis
- Juvenile Idiopathic Arthritis (JIA): This is the most common chronic disease causing joint pain and swelling in children. It is characterized by joint inflammation and can present with various symptoms, including morning stiffness, limited range of motion, and systemic features like fever and rash.
Other Likely diagnoses
- Trauma or Overuse Injury: Children are often active, and injuries to the joints or surrounding tissues can cause pain and swelling. A thorough history and physical examination can help identify recent trauma or repetitive activities that may have led to the symptoms.
- Infectious Arthritis: Although less common, bacterial, viral, or fungal infections can cause joint pain and swelling. The presence of fever, redness, and warmth around the joint, along with limited mobility, should raise suspicion for an infectious cause.
- Lyme Disease: In endemic areas, Lyme disease can cause arthritis, particularly in children. It often presents with a distinctive rash (erythema migrans) followed by joint symptoms weeks to months later.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Septic Arthritis: This is a medical emergency where a bacterial infection causes joint inflammation. It requires prompt diagnosis and treatment to prevent long-term joint damage and potential systemic complications.
- Malignancy (e.g., Leukemia): Although rare, certain types of cancer, such as leukemia, can initially present with joint pain and swelling due to the spread of cancer to the bones or joints. A high index of suspicion is necessary, especially if there are accompanying systemic symptoms like weight loss, fatigue, or pallor.
- Henoch-Schönlein Purpura (HSP): This condition is characterized by a specific type of vasculitis that can cause joint pain, along with a distinctive rash, abdominal pain, and sometimes kidney involvement.
Rare diagnoses
- Rheumatic Fever: Following a group A streptococcal infection, rheumatic fever can occur, leading to joint pain (migrating polyarticulitis), along with other symptoms like carditis and chorea.
- Sarcoidosis: A rare condition in children, sarcoidosis can cause joint pain and swelling as part of a systemic disease that affects multiple organs, including the lungs, skin, and eyes.
- Autoimmune Disorders (e.g., Systemic Lupus Erythematosus): While more common in adults, these conditions can occasionally present in children, causing a variety of symptoms including joint pain and swelling, skin rashes, and systemic features.