Diagnostic criteria for elbow injury in children with juveAleksei N. Kozhevnikovnile arthritis

Juvenile arthritis is a severe inflammatory disease of pediatric musculoskeletal system that leads to the development of contractures, early disability and loss of joint function. An isolated elbow injury in children with juvenile arthritis (JA) is a rare condition that is diagnosed at a late stage and has a poor prognosis. Early diagnosis using a variety of imaging modalities is vital for maintaining elbow function and decreasing disability rate in children. Objective To specify diagnostic methods and clinical and laboratory tests that allow visualization of JA-specific signs in pediatric elbow. Material and methods The retrospective study included 15 children who received treatment for chronic arthritis of the elbow joint. Clinical and instrumental findings, dynamics in articular syndrome and efficacy of antirheumatic therapy were evaluated. Results and discussion The study allowed us to reveal specific features of elbow injury in children with JA. 1. The onset associated with an injury to the upper limb and ‘mute’ laboratory tests were observed in more than 80 % of the cases. 2. Clinical examination of patients with JA showed absence of morning stiffness and evident pain, dry synovitis and joint contracture in most of the cases. 3. Radiological evaluation exhibited early erosion of the subchondral bone at the articular surface of olecranon. 4. There was a slight monotherapeutic effect on elbow joint synovitis noted with NSAID use. 5. Diagnosis of pediatric chronic arthritis of the elbow joint suggests a complex approach to evaluation of clinical and instrumental findings and their dynamics taking into consideration age related specific anatomy of the elbow that can facilitate detection of the underlying cause of chronic arthritis.