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Abstract Number: 2402

Predictive Value of the History and Labs in Distinguishing Inflammatory from Non-Inflammatory and Mechanical Joint Pain

Sonora Williams1, Tracy R. Andrews2, Yukiko Kimura3, Jennifer E. Weiss4, Suzanne C. Li5, Kathleen Haines6, Maddalena Allegretta7, Alisha Valdez7 and Ginger Janow8, 1University of Florida, Gainesville, FL, 2Biostatistics, David & Alice Jurist Institute, Hackensack University Medical Center, hackensack, NJ, 3Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, 4Hackensack Univ Med Ctr, Hackensack, NJ, 5Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, 6Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, 7Rutgers New Jersey Medical School, Newark, NJ, 8Pediatric Rheumatology, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Diagnosis and pediatric rheumatology

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Session Information

Date: Tuesday, November 15, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster III: Systemic JIA, Autoinflammatory Syndromes, Scleroderma, Vasculitis, Miscellaneous

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Predictive Value of the History and Labs in Distinguishing Inflammatory from Non-Inflammatory and Mechanical Joint Pain

Background/Purpose:  Joint pain is one of the most common reasons for referral to pediatric rheumatology clinics throughout the world.  Typically, these patients ultimately fall into one of 3 categories of diagnosis: (1) inflammatory, (2) non-inflammatory, or (3) mechanical, each requiring different management. Our objective was to determine what factors on clinical history best predict the final etiology of the joint pain in the 3 categories. 

Methods: New patients between the ages of 2 and 22 seen by the pediatric rheumatology clinic at Hackensack University Medical Center between 1/1/2013 and 12/31/2014 with joint pain were included in our retrospective chart review. Data were collected regarding demographics, symptom history, and physician assessment. Final diagnosis was categorized as one of the 3 stated categories. Univariate statistics were performed for all covariates in the sample. Significant differences were tested using a Fisher’s Exact test. A multivariate multinomial regression model was estimated to assess whether the characteristics associated with Mechanical or Non-inflammatory joint pain were significantly different than Inflammatory joint pain. A multinomial logistic regression was performed as there was not an inherent ordering of severity of the groups of joint pain.

Results:   288 charts were included in the analysis.  31.6% were inflammatory, 25.35% non-inflammatory, and 28.47% mechanical (table 1).  42 patients, or 14.58% of the patients did not have a clear final diagnosis, with either resolution of their symptoms or failure to follow up.  These patients were not included in the multivariate multinomial regression analysis.  An abnormal CRP, presence of swelling, a lower pain score and the absence of a history of anxiety or depression increased the odds of inflammatory joint pain as compared to non-inflammatory.  Compared to patients who have symptoms present for <6 weeks, patients who have symptoms for 3-12 months are 6.89 times more likely to have mechanical pain (OR= 6.893, p=0.0370) and 8.85 times more likely to have non-inflammatory pain than to have inflammatory pain (OR=8.854, p=0.0772) (table 2).

Conclusion:   Our results indicate that while patients with non-inflammatory pain have higher pain scores, a longer duration of pain and perhaps more subjective pain, the objective data (swelling and increased CRP) are more consistent with inflammatory joint pain.  This information is especially useful for the general pediatrician when triaging patients with joint pain and deciding upon referrals.  Educating pediatricians could result in better management and therefore improved outcomes.

Table 1. Breakdown of diagnosis by category

Inflammatory

Non-Inflammatory Mechanical
Dactylitis JDM HSP JIA/RA Lyme arthritis Reactive arthritis PSRA Rheumatic fever Serum sickness SLE Systemic sclerosis UCTD Vasculitis KD Fibromyalgia RSD Growing pains Chondrolysis Costochondritis Hypermobility Overuse syndrome Patellofemoral Pain Tendonitis TMJ syndrome Trauma

Table 2.  Odds ratio of mechanical and non-inflammatory cause versus inflammatory

95% Confidence Interval

Diagnosis

Odds Ratio

Low

High

P Value

Abnormal CRP

0.0294

   Mechanical

0.176

0.046

0.673

0.024

   Non-inflammatory

0.086

0.013

0.555

0.0066

History of Anxiety or Depression

0.0003

   Mechanical

8.129

2.127

31.061

0.0022

   Non-inflammatory

16.696

4.258

65.471

<.0001

30+ Minutes of Morning Stiffness

0.0752

   Mechanical

0.152

0.027

0.845

0.0314

   Non-inflammatory

0.306

0.058

1.6

0.1605

PAIN VAS

0.0037

   Mechanical

0.969

0.822

1.142

0.0037

   Non-inflammatory

1.254

1.048

1.499

0.0132

Presence of swelling

0.0252

   Mechanical

0.748

0.328

1.707

0.4909

   Non-inflammatory

0.262

0.096

0.712

0.0086

Symptom Duration

0.0056

   6 wks-3 mo vs  vs <6 wks: Mechanical

2.429

0.646

9.128

0.6362

   6 wks-3 mo vs  vs <6 wks: Non-inflammatory

4.559

0.912

22.778

0.8111

   3-12 mo vs <6 wks: Mechanical 6.893

2.131

22.294

0.037

   3-12 mo vs <6 wks: Non-inflammatory

8.854

2.178

36.001

0.0772

  1+ yr vs  <6 wks: Mechanical

4.995

1.86

13.412

0.1256

  1+ yr vs <6 wks: Non-inflammatory 6.382

1.954

20.848

0.2133


Disclosure: S. Williams, None; T. R. Andrews, None; Y. Kimura, Novartis, SOBI, 5,CARRA, Inc (salary support), 9; J. E. Weiss, None; S. C. Li, None; K. Haines, None; M. Allegretta, None; A. Valdez, None; G. Janow, None.

To cite this abstract in AMA style:

Williams S, Andrews TR, Kimura Y, Weiss JE, Li SC, Haines K, Allegretta M, Valdez A, Janow G. Predictive Value of the History and Labs in Distinguishing Inflammatory from Non-Inflammatory and Mechanical Joint Pain [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/predictive-value-of-the-history-and-labs-in-distinguishing-inflammatory-from-non-inflammatory-and-mechanical-joint-pain/. Accessed .
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