In this section
Acutely swollen joints may reflect local pathology (eg. trauma,
sepsis) or generalised pathology localised to a joint(s) (eg.
vasculitis, post-infective arthritis). The differential diagnosis
is wide and making a precise diagnosis in the acute situation can
be difficult. Often the diagnosis only becomes apparent with time
and initial treatment is on a presumptive basis. For a significant
number of patients this involves symptomatic measures only.
In the acute phase the most important tasks are to identify
those conditions requiring more than just symptomatic treatment,
and to ensure that those being treated symptomatically have
In many cases there may not be a clear diagnosis by the end of
the child's assessment in the emergency department - the results of
some investigations may not be available for days, and others may
help only in 'ruling-out' certain conditions. For such children,
symptomatic outpatient treatment with non-steroidal
anti-inflammatory drugs (eg. naproxen) with careful follow-up is
appropriate. These children should be followed closely until their
symptoms resolve or the diagnosis becomes clear.
Any child with symptoms not resolved after four weeks or any
child in whom NSAIDs do not provide adequate relief of symptoms
should be re-evaluated.