When joint pains are more than just pains

One of the most common reasons for referral to a pediatric rheumatologist is joint pain, often with the suspicion that the pain is due to arthritis. These two terms are sometimes used synonymously, creating much anxiety and worry in parents leading up to the office visit with a pediatric rheumatologist. There are a myriad of reasons your child may have joint pain, and my job as a pediatric rheumatologist is to figure out if the pain is more than just pain, or due to arthritis – a term that refers to inflammation in the joint.

This can be challenging since children can't always describe what they're feeling or experiencing. So, how can you tell if you should be concerned for arthritis? Start by asking one simple question...when do the symptoms occur?

Joint pain from an inflammatory arthritis occurs mostly in the morning. Older patients describe this feeling as "stiffness" that makes them feel weak or have difficulty performing activities such as combing their hair or brushing their teeth. In younger patients, parental observations can be used to describe this stiffness. For example, many parents notice their child has a limp that is worse in the morning and improves throughout the day, swelling in the knee or ankle, or their child complains of knee pain right after he or she wakes up in the morning or after a nap. Parents might also notice their child becomes stiff and weak after a long car ride. These symptoms are noted mostly in the morning or after periods of inactivity due to something called "gelling" inside of the joint – named after the behavior of gelatin, which remains in liquid form if it is kept moving and warm, but solidifies if it sits for long.

The most common type of inflammatory arthritis in children is JIA, or juvenile idiopathic arthritis. The term idiopathic means this is a condition that arises spontaneously for which the cause is unknown. JIA affects 1 in 1,000 kids, or approximately 300,000 children in the U.S. It usually appears between 6 months and 16 years of age, with symptoms of arthritis that last for a minimum of six weeks.

If your child is experiencing these symptoms, talk to your pediatrician because, although not common, kids get arthritis too!