Musculoskeletal (MSK) complaints are very common in children, who present to general practitioners, paediatricians and orthopaedic surgeons. Studies have reported that they may occur in 4-30% of the community. A Scottish study showed that 1 in every 58 children presenting to a paediatric accident and emergency unit had limping as their primary complaint, and a survey of adolescents in British Columbia revealed that MSK complaints were viewed as the most common health concern after acne. [1-4] The differential diagnosis for a child presenting with MSK pain ranges from dreadful to completely benign (Table 1). An accurate diagnosis of juvenile idiopathic arthritis (JIA) depends on a good clinical approach, clues derived from the history and examination, and pattern recognition, which will assist the clinician in making the diagnosis. A thorough history and examination are the most important tools to make the diagnosis of JIA, where early diagnosis and treatment have been shown to directly improve outcomes. [5] Children are constantly growing and developing, and changing milestones, anatomy and physiology increase the difficulty of making the diagnosis of JIA. Methods This brief review summarises the available and relevant evidence on the diagnosis and management of JIA in the South African (SA) context and is intended to assist the non-specialist in the identification, management and referral of these patients. Sources of relevance were drawn from published medical literature (searched via Medline), authoritative texts and online resources on paediatric rheumatology.
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Afrikaans language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach’s alpha, interscale correlations, test–retest reliability, and construct validity (convergent and discriminant validity). A total of 91 JIA patients (4.4% systemic JIA, 35.1% oligoarticular, 23.1% RF negative polyarthritis, 37.4% other categories), and 98 healthy children were enrolled in one paediatric rheumatology centre. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed satisfactory psychometric performances. In conclusion, the Afrikaans version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and in clinical research.
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