A friend called the other day to ask me what her grandchild's parents should do about the joint pain their five-year-old was having. The pediatrician didn't have any answers. The family live near the good Washington D.C. Children's Hospital, so I said they should make and appoint with a rheumatologist there. They also needed to make an appointment with a pediatric ophthalmologist and have a slit lamp examination done. The eyes can be affected in this disorder. When I was running a program for children with disabilities at Oakland Children's Hospital I stared an arthritis clinic and had a rheumatologist come down from UC Davis Medical Center to consult. She taught me a lot. I remember we had one teenager who was blind because her eyes had not been taken care of. She had fairly severe JRA. Unfortunately, the blood tests for JRA can be negative, so you have to be sure and take a good history and do a good physical examination.
When I was working in the neuromuscular unit at USC, the director asked me to see a child who was referred for a work-up. The child was having hip pain at night and had no muscle weakness. My diagnosis was JRA and a year later the director told me my diagnosis was correct even though they had done a complete neuromuscular work-up. Sadly, this is not one of those disorders that is often taught to medical students and residents, so a good rheumatologist is usually needed
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