Could early presentation and diagnostics predict JIA: an analysis of pediatric patients presenting to ped with non-traumatic joint pain

Abstract

Introduction: Juvenile idiopathic arthritis (JIA) is chronic autoimmune disorder characterized by infammation of one or more joints leading to stifness, swelling, and pain. Early JIA diagnosis and treatment can improve outcomes. Many other diseases can mimic initial episode of JIA; thus, it is crucial to identify early signs of chronic disease. Objectives: We aimed to determine distribution of symptoms and treatment as well as most frequent diagnostic tests in patients presenting with joint pain to a pediatric emergency department (PED). Methods: Retrospective data analysis from electronic healthcare record system was conducted. Data of all children presenting to PED complaining of joint pain January 2018-February 2022 were analysed. Cases were divided into two groups: children progressing to chronic form of the disease (JIA), and those who did not (nJIA). Statistical data analysis was performed using SPSS 29.0. P value <0.05 was considered signifcant. Results: Data of 110 children (55 JIA, 55 nJIA) were analysed; 63.6% were female. Median age was 12 (6-15) and did not difer in both groups. Median days from the onset of symptoms did not difer (61d as for JIA vs 31d as for nJIA, p>0.05). Pain was predominant symptom in both groups (92.73%-JIA; 89.1%-nJIA). Children complained of joint swelling and joint stifness more frequently in JIA group compared to nJIA (74.5% vs 47.3% and 41.8% vs 29.1% respectively). In PED, CBC was performed in 99.09% (n=109) cases, ESR in 93.64% (n=103). However, only eosinophil count was higher in JIA compared to nJIA (0.2x10*9 (0.1;0.32) vs 0.13x10*9 (0.08;0.2)). All were referred to pediatric rheumatologist. During follow-up, ANA was tested in 84.5% (n=94). 54.5% (n=61) had positive result of which 62.3% were from JIA group. In PED, 105 children (95.5%) received joint ultrasound. Efusion was found in 75 patients (71.4%), of which 56% belonged to the JIA group. In the same group, one joint involvement prevailed (n=30, 60%), polyarthritis was diagnosed only in 3 patients (6%). Less than half of nJIA patients (n=22, 40%) presented with no joint pathology in ultrasound. All patients were prescribed NSAIDs in PED. Conclusion: Our research uncovered that the pain symptom predominated in both patients with subsequent JIA and without at the visit to PED. None of investigations in PED was able to identify chronic disease. Therefore, all patients suspected of nontraumatic joint pain should be referred to pediatric rheumatologist.