Identifying Children With Chronic Arthritis Based on Chief Complaints: Absence of Predictive Value for Musculoskeletal Pain as an Indicator of Rheumatic Disease in Children

McGhee, Julie L; Burks, Frank; Sheckels, Julie L; Jarvis, James N.

doi:10.1542/peds.110.2.354

Cited by 106 publications

(60 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Careful performance of a competent musculoskeletal examination is vital to the diagnostic process, particularly because musculoskeletal symptoms are not always easily volunteered by children, parental observations may be nonspecific (e.g., "my child is limping"), and joint swelling and abnormal gait (such as limp) rather than reported pain are the most common presenting features of JIA (5,6).…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal screening examination (pGALS) for school‐age children based on the adult GALS screen

Foster

Kay

Friswell

et al. 2006

Arthritis & Rheumatism

129

View full text Add to dashboard Cite

Objective. To develop and validate a musculoskeletal screening examination applicable to school-age children based on the adult Gait, Arms, Legs, Spine (GALS) screen.Methods. Adult GALS was tested in consecutive school-age children attending pediatric rheumatology clinics and was compared with an examination conducted, on the same day, by a pediatric rheumatologist who classified children as having abnormal or normal joints. Adult GALS was tested for validity compared with the pediatric rheumatologist's assessment and deficiencies in adult GALS were identified. Experts proposed amendments to adult GALS, achieving consensus by modified Delphi techniques. The resultant pediatric screening tool (pGALS) was tested (methodology identical to the testing of adult GALS) in an additional group of children.Results. Adult GALS was tested in 50 children (median age 11 years, range 4 -16), of whom 37 (74%) had juvenile idiopathic arthritis. Adult GALS missed important abnormalities in 18% of children, mostly at the ankle, foot, and temporomandibular joints. The pGALS was tested in 65 children (median age 13 years, range 5-17 years) and demonstrated excellent sensitivity (97-100%) and specificity (98 -100%) at all joints, with high acceptability scored by child and parent/guardian. The median time to perform pGALS was 2 minutes (range 1.5-3 minutes). Conclusion. The pGALS musculoskeletal screening tool has excellent validity, is quick to perform, and is acceptable to school-age children and parents/guardians. We propose that pGALS be incorporated into undergraduate and postgraduate medical training to improve pediatric musculoskeletal clinical skills and facilitate diagnosis and referral to specialists.

show abstract

Section: Introductionmentioning

confidence: 99%

Musculoskeletal screening examination (pGALS) for school‐age children based on the adult GALS screen

Foster

Kay

Friswell

et al. 2006

Arthritis & Rheumatism

129

View full text Add to dashboard Cite

show abstract

“…The pathogenesis of JIA seen in the cervical spine is similar to others joints, with synovial inflammation, hyperaemia, and pannus formation [1,13]. The indolent process of leucocyte infiltration into the synovium and proliferation of the synovial tissue lead to a subacute type of inflammation, which may justify that pain is not the most conspicuous feature of clinical presentation of JIA, that may pain be missed, particularly in oJIA [13].…”

Section: Case Seriesmentioning

confidence: 98%

“…The indolent process of leucocyte infiltration into the synovium and proliferation of the synovial tissue lead to a subacute type of inflammation, which may justify that pain is not the most conspicuous feature of clinical presentation of JIA, that may pain be missed, particularly in oJIA [13]. This may justify the frequent absence of neck pain in JIA, regardless of CSI, and its worse prognosis [3].…”

Section: Case Seriesmentioning

confidence: 99%

See 1 more Smart Citation

Cervical arthritis as presentation of oligoarticular juvenile idiopathic arthritis

Coutinho¹,

Estanqueiro²,

Alves³

et al. 2017

Ann Paediatr Rheum

View full text Add to dashboard Cite

“…These findings were supported by Deane et al in a series of 31 children with positive ANA (by IFA) and no initial diagnosis of autoimmune disease followed over approximately 3 years (8). Another study found that children referred because of a positive ANA (by IFA) were no more likely to be diagnosed with a chronic inflammatory disease than children who lacked this testing (9). These studies suggest that many children referred to pediatric rheumatology clinics for positive ANA will not be diagnosed with a rheumatic disease.…”

Section: Do Not Order Autoantibody Panels Unless Positive Anas and Evmentioning

confidence: 99%

Choosing Wisely: The American College of Rheumatology's Top 5 for Pediatric Rheumatology

Rouster‐Stevens

Ardoin

Cooper

et al. 2014

Arthritis Care & Research

View full text Add to dashboard Cite

Objective. To create a pediatric rheumatology Top 5 list as part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.Methods. Delphi surveys of a core group of representative pediatric rheumatology providers from across North America generated candidate Top 5 items. Items with high content agreement and perceived to be of prevalent use and of high impact were included in a survey of all American College of Rheumatology (ACR) members who identified themselves as providing care to pediatric patients. Items with the highest ratings were subjected to literature review and further evaluation. Results. A total of 121 candidate items were proposed in the initial Delphi survey and were reduced to 28 items in subsequent surveys. These 28 items were sent to 1,198 rheumatology providers who care for pediatric patients, and 397 (33%) responded. Based upon survey data and literature review, the Top 5 items were identified. These items focused on testing for antinuclear antibodies, autoantibody panels, Lyme disease, methotrexate toxicity monitoring, and use of routine radiographs. Conclusion. The ACR pediatric rheumatology Top 5 is one of the first pediatric subspecialty-specific Choosing Wisely Top 5 lists and provides an opportunity for patients and providers to discuss appropriate use of health care in pediatric rheumatology. whose routine use, based upon available evidence, may add to the cost of care without improving quality of care. As the US struggles to reduce health care costs without jeopardizing quality of care, physician involvement is needed to develop strategies to reduce health care spending (1). In 2011, the ABIM Foundation launched the Choosing Wisely campaign, encouraging medical societies to identify sources of unnecessary spending. Partnering societies were charged with developing a Top 5 list of tests, treatments, or services commonly used by that specialty that have high aggregate costs and are unnecessary or potentially harmful. Recommendations were based on clinical guidelines and available evidence (2). The Top 5 lists are intended to be widely disseminated to physicians and patients, prompting discussions about the utility and optimal use of these tests and interventions (3). The Top 5 list aims to raise awareness of potentially wasteful interventions but not replace clinical judgment or individualized care, and each item includes information about when the test or procedure may be appropriate. The American College ofTo date, 51 medical societies have participated in the Choosing Wisely campaign (3), and in March 2013, the ACR published a Top 5 list (4). Given the unique needs of the pediatric rheumatology population, the ACR supported the parallel development of this ACR pediatric rheumatology Top 5 list. This list is the product of a multistep process that included survey and consensus techniques and extensive literature reviews, ensuring that the final items reflect expert opinion and best available evidence. MATERIALS AND METHODSThe ACR Special Committee on Pediatric...

show abstract

Identifying Children With Chronic Arthritis Based on Chief Complaints: Absence of Predictive Value for Musculoskeletal Pain as an Indicator of Rheumatic Disease in Children

Cited by 106 publications

References 20 publications

Musculoskeletal screening examination (pGALS) for school‐age children based on the adult GALS screen

Musculoskeletal screening examination (pGALS) for school‐age children based on the adult GALS screen

Cervical arthritis as presentation of oligoarticular juvenile idiopathic arthritis

Choosing Wisely: The American College of Rheumatology's Top 5 for Pediatric Rheumatology

Contact Info

Product

Resources

About