Is this really arthritis or just a reaction to infection?

[choirmum]

Bear with me on this one as I know a little knowledge is a dangerous thing. My DD (age 11) has always been very healthy. Had tonsilitis in May and developed a swollen, painful knee shortly afterwards. Saw an orthopaedic surgeon who discharged her as it wasn't swollen by the time she got seen. Knee has swollen on and off all summer so she was referred back to orthopaedics (I suggested to GP that rheumatology might be more appropriate but was overruled). She's had blood tests and is waiting for an MRI scan (another 6 weeks to wait). She's now had another bout of tonsilitis and both knees, an ankle and some joints in her hand have become swollen and painful and she just doesn't feel right. Her bloods are okay but (for those in the know) her alk phos is raised and she has a weakly positive ANA. I know that it's perfectly possible to have normal bloods and still have inflammatory arthritis. I want to insist that she's referred promptly to a paediatric rheumatologist as I don't think a 6 week wait for a scan which might not show anything is reasonable but I work as a rheumatology nurse and don't want to overstep the mark or look for problems which aren't there. As a mum, my gut tells me that she needs to see a rheumatologist pronto!

[denialandpanic]

choirmum, you are right. I understand why you are hesitating but if it were my dc i would be nagging the gp. I hope you get some answers soon.
I have psoriatic arthritis and my daughter is quite an achy child. my blood runs cold every time she mentions her sore knee again. so my child hasn't even had any "typical" our serious symptoms and I'm keeping a watchful eye.

[denialandpanic]

Can you refer them calmly to nice guidelines? surely two times episodes of swollen joints with mild Ana pos etc at least justifies referral?

[candycoatedwaterdrops]

You're a rheumatology nurse, so unless the GP has a special interest in this area, I'm going to assume that you are far more knowledgeable on this sort of thing than the GP! Insist on a paediatric rheum referral. As I'm sure you know, early dx makes all the difference in inflammatory arthritis.

P.S. mental note to bother choirmum if I have any rheumatology questions.

[choirmum]

Spoke to GP yesterday who agrees rheumatology referral is appropriate and we should get a prompt appointment. DD now has croup on top of everything else and looks worn out. I'm sure these things are all linked and now need a professional to join the dots.

[denialandpanic]

I hope she gets an appointment soon choirmum. I hope it's not arthritis but add you know if it is it's important to know soon get well soon mini choirmum

[choirmum]

Thank you x

[choirmum]

Update - DD saw paediatric rheumatologist yesterday who thinks she's had a reactive arthritis and now has some kind of post-viral syndrome, like glandular fever. No treatment needed. I wish I felt reassured but she's now been systemically unwell for 7 weeks. No further blood tests were suggested and he didn't examine her other than looking at her joints. I don't want to become obsessive but she just isn't right!

[Sneezecakesmum]

Did they advise any anti inflammatories?

It's going to take a long time and a lot of resting to recover from all this as you already know. I think your gp can refer you to physio for when the inflammation settles and maybe a wheelchair until she can walk more comfortably.

[benfoldsfive]

my ds 6 had reactive jia and still has it nearly 2 years on (all though in remission thank god! ). He to had a sore throat followed by knee swelling on and off followed by other joints am happy to talk to you or . I buddy up if you like. Just because it is in reaction to an infection doesn't mean it will go away. What did the rhummy say? What course of treatment had she been put on?

[benfoldsfive]

just read what the rhummy said. request another opinion. JIA reactive or not does not go away. It can be a fight even with specialists to get the right treatment.

[NK5BM3]

I would push for another opinion. I say this as a mum of a ds who's 5 and was diagnosed after being warded at gosh for 2 weeks... In the rhuemy ward.

Before gosh took over, we were bounced around a&e and children's health centres in hospitals.. We were even seen by the paed rhuemy of our local hospital who told us it wasn't arthritis.

In the end it was a paed oncologist who happened to see us on another admission to the hospital who suggested that it might be systemic jia and wrote a referral to gosh. Within two days we had a phone call from gosh and an admission on the following Monday (the call came on Friday evening).

Ironically now gosh shares care with the local hospital and we see the local guy... Yup the same guy who told us it couldn't be arthritis coz he's the expert.

As a fellow professional I wanted to lamp him.

[choirmum]

Thanks all for your comments.
Rheumatologist thinks she might have had a reactive arthritis which has settled but left her with some muscle weakness and given her some exercises to do.
He may well be right in that there are 2 separate processes going on and her being unwell is post-viral. I did tell him that I work 'in the field' and asked if he was confident that there was no systemic or connective tissue problem and he said not.
If she doesn't improve over christmas, I'll be back to the GP. I don't want her well when she's resting but unable to function at normal levels of activity!

[Sneezecakesmum]

If you have any problems then the go can refer for some physiotherapy. You already know its important not to over stretch weak muscles as it may lead to further pain. Also unused muscles can stiffen and cause pain when trying to walk again. When the swelling and inflammation goes down and there is no heat in the joint, do some gentle stretches following gentle massage using oil.