Locations:
Search IconSearch
January 10, 2022/Pediatrics

Maintain a Broad Differential When Diagnosing Arthritis in Children

Patient with intermittent pain and swelling in knee initially appears to have juvenile idiopathic arthritis

21-RHE-2528508-Arthritis-in-children-Not-just-JIA-CQD_650x450

A 15-year-old male presented with right knee pain and swelling that had been intermittent for ten years.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Upon exam, juvenile idiopathic arthritis (JIA) appeared to be a preliminary diagnosis, although his symptoms were not emblematic of chronic arthritis. The swelling was episodic, occurring only every few months, and typically only lasting less than a week. After that, his knee felt completely normal.

An ultrasound confirmed arthritis in his right knee, but he had no fever or other positive findings for JIA. An X-ray and lab studies, which included: a complete blood count, inflammatory marker test, gonorrhea culture, Lyme disease, rheumatoid factor, cyclic citrullinated peptide antibodies and HLA-B27 tests were all normal. Additionally, the duration of pain and swelling did not support an infectious cause, and he was otherwise healthy without systemic rheumatologic conditions.

Joint aspiration was completed in clinic, allowing the team to retrieve serosanguinous fluid from the joint and inject a steroid.

The patient returned six months later with another episode of pain and swelling in his right knee. This time, the bedside ultrasound revealed an increase in Doppler signal within the Hoffa fat pad, which is not a typical site for synovitis JIA.

Arthritis in Children: Not Just JIA

MRI confirms new diagnosis: synovial hemangioma

The team proceeded with an MRI, which revealed a 4 cm mass within the Hoffa’s fat pad. The mass was multilocular with hyperintensity, consistent with synovial hemangioma, a rare benign tumor. He was referred to the Department of Orthopaedics, where the team led an arthroscopic excision of the mass and synovectomy.

The diagnosis, confirmed on histopathology, explained the off-and-on knee swelling was caused by episodic intraarticular bleeding and hemosiderotic synovitis.

Advertisement

What is the lesson?

In this case, JIA was a diagnosis of exclusion. When it comes to arthritis in children, maintain a broad differential of potential etiologies.

Advertisement

Related Articles

Seth Rotz, MD, exams patient's throat during clinical exam
Study Reveals New Clues Into Childhood Cancer Survivors’ Increased Risk of Melanoma

Largest study of its kind identifies three treatment exposures that contribute to risk

Caregiver holds object in front of face while engaging with child
March 7, 2025/Pediatrics/Autism
Program Supports Parents and Caregivers of Young Children With Autism Spectrum Disorder

Center for Autism to provide social, educational and skills-based program for families

Mom doing skin to skin with newborn
March 5, 2025/Pediatrics/Cardiology
Facilitating Neuroprotective Care for Infants With Congenital Heart Disease

Program will support family-centered congenital heart disease care and staff educational opportunities

Young girl sitting on couch looking off into the distance
Recognizing Eating Disorders in Youth: When Menstrual Dysfunction Is a Clue

Pediatric and adolescent reproductive providers are uniquely positioned to intervene

Photograph of 3D-printed patient heart model
February 18, 2025/Pediatrics/Cardiac Surgery
Novel Biventricular Fontan Conversion for Single-Ventricle Congenital Heart Disease

Case provides proof of concept, prevents need for future heart transplant

Child on playground equipment
Advancing Understanding and Care for Adolescent Obesity

Complex disease requires a comprehensive approach

Child hugging mother who is pregnant
Pediatric Malaria Studies Will Help Inform Vaccine Strategies

Investigating asymptomatic parasitemia will also contribute to knowledge of disease immunity

Hands holding devices in training simulation
February 3, 2025/Pediatrics/Surgery
First Neonatal Minimally Invasive Surgical Symposium Expands Access to MIS Care

Center touts the benefits of neonatal MIS, trains others on the approach

Ad