Bones and Joints Problem Specialist Answer

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ISSN 0973 - 0958

Childhood Ailments

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	Specialist Answers
Question
Swollen knees. I have a 22 month, 12 kg weight, male child. Since March 22, 2004, he walks keeping with the left leg straight. He was diagnosed with a transient heap sinuvitis. He was treated with traction using 2 Kg weights for 72 continuous hours. X rays do-not show any bone defect. Reactive protein C levels remain high ( +- 38-40 mg/dl), sedimentation velocities are also high (+- 60 mm /hr 1st. hour, +- 110 mm/hr 2nd hour). Latest X ray ( a week ago) shows some swelling on both knees. He has been through physical therapy for the last week. While at rest, he bends his knees, but puts them straight when walking. Arthritis test were performed and the result was: negative Blood evaluation and appraisal by an hematologist indicated no problem Throat test was performed. A streptococci pneumonia appeared and was treated with antibiotics. Was it really sinovitis? Can anyone shade any light? A desperate father.
Answer
Multiple joint swellings are due to a variety of causes of which the commonest are rheumatic fever, juvenile rheumatoid arthritis and reactive arthritis due to infection. Since throat swab showed streptococcus, rheumatic fever should be ruled out. One should do an Also test. If all results are negative, it could be reactive arthritis and treatment would be symptomatic for the pain and swelling till the ESR comes down. Consult a pediatric rheumatologist. Back to All Questions

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